[Over-reduction after distal radius fracture pinning in young active patients: Prevention by multiple mixed pinning]

Over-reduction is a classical complication following pinning of distal radius fractures. Indeed, the pinning techniques derived from Kapandji's technique do not allow anterior stabilization. A literature review and our experience show that it is an underestimated complication that can affect up to one-third of cases, but that is well tolerated if the anterior tilt is less than 20°. Excessive angulation of the dorsal intrafocal K-wires becomes a significant risk factor beyond 60°. Volar comminution of the fracture is an obvious predisposing factor. We will outline our ideas on the topic and present a new pinning technique, which has reduced the over-reduction rate to below 3 %: multiple mixed pinning combines two dorsal intrafocal K-wires with two trans-styloid K-wires along the anterior and posterior cortices of the radius to provide true sagittal stabilization of the fracture. This technique is suitable for fractures without major instability or associated anterior comminution-Milliez types 1 and 2 are its best indications. In our practice, there still is a place for pinning of non-complex fractures in young active subjects. More than 20° malunion in flexion can lead to symptoms; in this instance, isolated opening osteotomy of the radius is the most suitable technique.