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Published on: September 16, 2022
Single versus double percutaneous pinning of pediatric distal radius fractures
Evan W Beatty1, Koya Osada2, Robert M Zbeda3
1Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Insights
Single-pin fixation and double-pin fixation are effective for unstable pediatric distal radius fractures. Both methods show similar complication rates, with double-pin fixation offering a minor, clinically insignificant reduction in displacement.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Skeletal Radiology
Background:
- Unstable pediatric distal radius fractures often require surgical intervention.
- Percutaneous pinning is a common fixation method for these fractures.
- Comparing single-pin versus double-pin techniques is crucial for optimizing outcomes.
Purpose of the Study:
- To compare early clinical and radiographic outcomes of single-pin versus double-pin fixation for pediatric distal radius fractures.
- To evaluate the effectiveness and complication rates of both fixation methods.
Main Methods:
- Analysis of 103 consecutive unstable pediatric distal radius fractures treated with single or double percutaneous pinning.
- Radiographic assessment of postoperative fracture displacement using anteroposterior and lateral views.
- Review of medical records for complication identification.
Main Results:
- Double-pin fixation showed a statistically significant, though clinically negligible, reduction in postoperative fracture displacement compared to single-pin fixation.
- No significant difference in complication rates was observed between the single-pin and double-pin groups.
- The single-pinning group was younger on average than the double-pinning group.
Conclusions:
- Both single-pin and double-pin fixation techniques are effective for unstable pediatric distal radius fractures.
- Appropriate fracture reduction and postoperative immobilization are key to successful outcomes regardless of the pinning technique.
- Clinical decision-making can consider either method based on surgeon preference and fracture characteristics.
Abstract:
The aim of this study was to compare early clinical and radiographic results of single- versus double-pin fixation of unstable pediatric distal radius fractures. A total of 103 consecutive closed distal radius fractures treated with either single or double percutaneous pinning at a tertiary level I pediatric hospital were analyzed. All patients had open physes and had fractures that failed initial closed reduction and casting. Postoperative fracture displacement was assessed by measuring the difference in angulation of the radius in the anteroposterior and lateral views from intraoperative fluoroscopic images to postoperative radiographs taken on the day of pin removal. Complications were identified from the medical record review. In 103 operative distal radius fractures in 101 patients (70 males, 31 females), 52 and 51 distal radius fractures were treated with single and double pinning, respectively. The median [interquartile range (IQR)] age at the time of surgery was 12.1 (9.0-14.0) years, with the single-pinning group being younger by 1.9 years ( P < 0.01). Median (IQR) postoperative angulation in the anteroposterior radiograph (coronal plane) was 2° (1-7°) with one pin versus 1° (0-2°) with two pins ( P < 0.01). Median (IQR) postoperative angulation in the lateral radiograph (sagittal plane) was 3° (1-10°) with one pin versus 1° (0-2°) with two pins ( P < 0.01). There were no significant differences in complications between the single- and double-pinning groups. Double-pin fixation resulted in a statistically significant, but clinically negligible, reduction in postoperative fracture displacement compared with single-pin fixation. Complication rates were similar in both groups. These findings suggest that either single- or double-pinning techniques can be effective, provided appropriate reduction and postoperative immobilization are achieved.
