Intrafocal pinning of distal radius fractures: a simplified approach

Distal radius fractures are not often treated by plastic surgeons. At the authors' institution, plastic surgery manages half of all traumas below the elbow, including distal radius and forearm fractures. This opportunity gives the residents a unique perspective for comprehensive training in treating upper extremity injuries. Because a distal radius fracture is the most common fracture of the upper extremity, the authors describe the use of intrafocal pinning as a simple and effective approach in the treatment of extra-articular distal radius fractures (Colles' fractures). They conducted a prospective study of 18 patients with Colles' fractures treated sequentially at their institution from 1998 to 2001 using this technique. They measured ulnar variance and palmar tilt of the distal radius at the time of injury, after closed reduction, immediately postoperatively, and 11 weeks postoperatively. Acceptable distal radius reduction aims to achieve at least neutral ulnar variance and 0-deg palmar tilt. Compared with closed reduction, they achieved superior anatomic reduction with intrafocal pinning: ulnar variance, +2.6 mm vs. -1.4 mm; palmar tilt, -13.3 deg vs. +2.1 deg). These results were stable at the 11-week follow-up. Intrafocal pinning is a valuable tool in the management of Colles' fractures. It is simple to perform and to teach, and it produces results that are superior to closed reduction alone.