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Early complications of percutaneous K-wire fixation in pediatric distal radius fractures-a prospective cohort study
Michał Wasiak1, Maciej Piekut2, Karol Ratajczak3,4
1Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland. michal.wasiak@uckwum.pl.
Insights
Closed reduction and percutaneous pinning (CRPP) for pediatric distal radius fractures (DRF) is safe, with few major complications. However, minor issues like pin-site inflammation are common and impact recovery.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Distal radius fractures (DRF) are the most common pediatric fractures, with inconclusive management evidence.
- Closed reduction and percutaneous pinning (CRPP) offers stability but carries risks.
- Lack of rigorous studies on CRPP complications in children necessitates further investigation.
Purpose of the Study:
- To prospectively evaluate the adverse events of CRPP for pediatric DRF.
- To utilize a validated grading system for complication assessment.
- To provide reliable data on risks and benefits in clinical scenarios.
Main Methods:
- Prospective cohort study of 119 DRFs (116 patients) treated with CRPP.
- Standardized follow-up at 4 weeks, 5 weeks, 3 months, and 6 months.
- Clavien-Dindo-Sink grading for complications and Dahl score for pin sites.
Main Results:
- Overall complication rate was 37% (44 complications).
- 35.3% had Grade I or II complications; 1.7% had Grade III.
- Most common minor complication was pin-site inflammation (33.6%); two patients needed re-operation.
Conclusions:
- CRPP is a safe treatment for pediatric DRF with a low rate of severe complications.
- Minor adverse events, particularly pin-site issues, are frequent and affect patient well-being.
- Rigorous grading systems enhance data quality and awareness of potential complications like pin tract infections.
Introduction:
Distal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures.
Materials And Methods:
One hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien-Dindo-Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites.
Results:
Forty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery-deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common-40 wrists (33,6%).
Conclusions:
The CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient's postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.
