Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

Abstract

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.

Efficiency of Orthopaedic Audits in a Level-1 Trauma Centre Using a Modified Clavien–Dindo Complications Classification

“…It was not adapted for use in an orthopaedic trauma population. Due to this study, many orthopaedic departments now refer to the classification system as the "Clavien-Dino-Sink" classification system [13][14][15][16].…”

Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children

“…The rate of re-displacement after manipulation of displaced distal radius fractures is approximately 21%–39%; many predisposing factors for re-displacement have been reported, most importantly, associated ulnar fracture, the degree of initial displacement, and casting and padding techniques [ 4 – 8 ].…”

“…The rate of complications following surgical treatment for distal radius fractures in children ranges from 6 to 80%, The most common complications following K-wire fixation are loss of reduction, pin tract infections, sunken K-wires, neuropraxia of the superficial radial nerve, and tendon irritation [ 8 , 12 ]. The wide range in the literature is not the same as in adults where dates are similar in different reports in different times, sample sizes, and places giving more reliable reference and robust evidence for the real rate of complications [ 13 – 15 ].…”