Comparison between closed reduction plaster casting and percutaneous Kirschner wire pinning in the management of distal radius fractures in patients aged 65 years and older

Year 2022, , 1631 - 1638, 25.10.2022

Selami Karadeniz , Alparslan Yurtbay , Özkan Öztürk , Ahmet Ersoy , Emre Çalışal , Ahmet Pişkin

https://doi.org/10.32322/jhsm.1176581

Abstract

Aim: Closed reduction plaster casting (CRPC) and percutaneous pinning (CRPP) remain an important treatment modalities for extra-articular distal radius fractures especially in elderly patients. These two treatment methods have advantages and disadvantages compared to each other. The ideal treatment of extra-articular distal radius fractures is still debatable. We aimed to retrospectively evaluate the clinical and radiological results after CRPC and CRPP for the treatment of distal radius fractures in the patient population over 65 years of age.
Material and Method: Between 1 January 2015 and 1 January 2019, patients older than 65 years of age who presented with extra-articular noncomminuted distal radius fractures were retrospectively evaluated. 95 patients diagnosed with distal radius fracture were separated into 2 groups, who were administered the following: CRPC (n:51), CRPP (n:44). We compared the characteristics of the patients, the mechanisms of injury, fracture types and treatment methods, pre-reduction and post-reduction radiological parameters and clinical functions for the two groups. Volar tilt, radial inclination, ulnar variance, and radial length were compared. Clinical results were also compared.
Results: The mean follow-up period was 19.8 months (range, 12-29 months; SD=11.0) in the CRPC group and 18.6 months (range, 12-26 months; SD=10.9) in the CRPP group. Mean range of motion and grip strength were maintained in both treatment groups at one-year follow-up. There was no statistically significant difference between the groups (p>0.05). There was no statistically significant difference between the groups in terms of the scores evaluating the daily activity, pain and mental status of the patients after the treatment (p>0.05). There are no statistically significant differences between fixation with CRPC and CRPP in terms of clinical and radiological results (p>0.05).
Conclusion: Closed reduction plaster casting and closed reduction percutaneous pinning are equally effective in the treatment of extra-articular distal radius fractures in the elderly.

Keywords

Distal, radius fracture, closed fracture reduction, fracture fixation, Kirschner wires

References

• Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991; 73: 461-9.
• Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28: 113-25.
• Mensforth RP, Latimer BM. Hamann-Todd Collection aging studies: osteoporosis fracture syndrome. Am J Phys Anthropol 1989; 80: 461-79.
• Randomised TC, Group OSoSfFitDRitES. Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial. JAMA Surgery 2021; 156: 229-37.
• Chhabra AB, Yildirim B. Adult Distal Radius Fracture Management. JAAOS - Journal of the American Academy of Orthopaedic Surgeons 2021; 29: e1105-e16.
• Colles A. On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 2006; 445: 5-7.
• Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93: 2146-53.
• Horne JG, Devane P, Purdie G. A prospective randomized trial of external fixation and plaster cast immobilization in the treatment of distal radial fractures. J Orthop Trauma 1990; 4: 30-4.
• Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2003; 3: Cd003209.
• Marcheix P-S, Dotzis A, Benkö P-E, Siegler J, Arnaud J-P, Charissoux J-L. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. Journal of Hand Surgery (European Volume) 2010; 35: 646-51.
• Brogren E, Hofer M, Petranek M, Dahlin L, Atroshi I. Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2–4 years after fracture. Journal of Hand Surgery (European Volume) 2011; 36: 568-76.
• Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones: Springer Science & Business Media; 2012.
• Frykman G. Fracture of the distal radius including sequelae, shoulder-hand syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function; A clinical and experimental study. Acta Orthop Scand 1967; 18: 108.
• Niver GE, Ilyas AM. Carpal tunnel syndrome after distal radius fracture. Orthopedic Clinics 2012; 43: 521-7.
• Kamal RN, Shapiro LM. American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand Clinical Practice Guideline Summary Management of Distal Radius Fractures. JAAOS - Journal of the American Academy of Orthopaedic Surgeons 2022; 30: e480-e6.
• Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am 2008; 33: 1301-8.
• McQueen M, Hajducka C, Court-Brown C. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. The Journal of Bone and Joint Surgery British volume 1996; 78: 404-9.
• Bechtol CO. Grip test: the use of a dynamometer with adjustable handle spacings. JBJS 1954; 36: 820-32.
• Crosby CA, Wehbé MA. Hand strength: normative values. The Journal of hand surgery 1994; 19: 665-70.
• Sheehan N, Sheldon F, Marks D. Grip strength and torquometry in the assessment of hand function in patients with rheumatoid arthritis. Rheumatology 1983; 22: 158-64.
• Jung J, Baek G, Kim J, Lee Y, Chung M. Changes in ulnar variance in relation to forearm rotation and grip. The Journal of Bone and Joint Surgery British volume 2001; 83: 1029-33.
• Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. The Journal of hand surgery 2000; 25: 19-28.
• McQueen M. Redisplaced unstable fractures of the distal radius: a randomised, prospective study of bridging versus non-bridging external fixation. The Journal of Bone and Joint Surgery British Volume 1998; 80: 665-9.
• Van der Linden W, Ericson R. Colles' fracture. How should its displacement be measured and how should it be immobilized? The Journal of Bone and Joint surgery American Volume 1981; 63: 1285-8.
• Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. The Journal of hand surgery 1982; 7: 376-9.
• Walenkamp MM, Goslings JC, Beumer A, et al. Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial. BMC Musculoskelet Disord 2014; 15: 90.
• Ducournau F, Meyer N, Xavier F, Facca S, Liverneaux P. Learning a MIPO technique for distal radius fractures: Mentoring versus simple experience versus deliberate practice. Orthop Traumatol Surg Res 2021; 107: 102939.
• Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000; 25: 19-28.
• Haane C, Mardin WA, Schmitz B, et al. Pancreatoduodenectomy—current status of surgical and perioperative techniques in Germany. Langenbeck's archives of surgery 2013; 398: 1097-105.
• Bruyere A, Vernet P, Botero SS, Igeta Y, Hidalgo Diaz JJ, Liverneaux P. Conservative treatment of distal fractures after the age of 65: a review of literature. Eur J Orthop Surg Traumatol 2018; 28: 1469-75.
• Ian AH, Justine MN, Lawson A, et al. A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)—a study protocol. BMJ open 2017; 7: e016100.
• Van Oijen GW, Van Lieshout EM, Reijnders MR, Appalsamy A, Hagenaars T, Verhofstad MH. Treatment options in extra-articular distal radius fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2021: 1-16.
• Chaudhry H, Kleinlugtenbelt YV, Mundi R, Ristevski B, Goslings J, Bhandari M. Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clinical Orthopaedics and Related Research® 2015; 473: 3017-27.
• Taleisnik J, Watson HK. Midcarpal instability caused by malunited fractures of the distal radius. The Journal of hand surgery 1984; 9: 350-7.
• Palmer AK. The distal radioulnar joint: anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clin 1987; 3: 31-40.
• Bonzar M, Firrell JC, Hainer M, Mah ET, MCCABE SJ. Kienböck disease and negative ulnar variance. JBJS 1998; 80: 1154-57.
• Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, et al. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022; 108: 103323.
• Mulders MAM, Detering R, Rikli DA, Rosenwasser MP, Goslings JC, Schep NWL. Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis. J Hand Surg Am 2018; 43: 710-9.e5.
• Cheng MF, Chiang CC, Lin CC, Chang MC, Wang CS. Loss of radial height in extra-articular distal radial fracture following volar locking plate fixation. Orthop Traumatol Surg Res 2021; 107: 102842.
• Hevonkorpi TP, Launonen AP, Raittio L, et al. Nordic Innovative Trial to Evaluate OsteoPorotic Fractures (NITEP-group): non-operative treatment versus surgery with volar locking plate in the treatment of distal radius fracture in patients aged 65 and over - a study protocol for a prospective, randomized controlled trial. BMC Musculoskelet Disord 2018; 19: 106.
• Ring D, Jupiter JB. Percutaneous and limited open fixation of fractures of the distal radius. Clinical Orthopaedics and Related Research (1976-2007) 2000; 375: 105-15.
• Clancey GJ. Percutaneous Kirschner-wire fixation of Colles fractures. A prospective study of thirty cases. The Journal of Bone and Joint surgery American Volume 1984; 66: 1008-14.
• Rayhack JM. The history and evolution of percutaneous pinning of displaced distal radius fractures. The Orthopedic clinics of North America 1993; 24: 287-300.
• Rodríguez-Merchán EC. Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age. J Orthop Trauma 1997; 11: 212-7.
• Stoffelen D, Broos P. Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures. J Hand Surg Am 1999; 24: 89-91.