Percutaneous pinning for treating distal radial fractures in adults

Karantana, Alexia; Handoll, Helen; Sabouni, Ammar

doi:10.1002/14651858.cd006080.pub3

Cited by 18 publications

(25 citation statements)

References 74 publications

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“…Interestingly, it was the largest of these previous studies, a secondary analysis of 461 patients included in a multicenter pragmatic RCT and allocated to either volar plate fixation or percutaneous pinning, which reported SSI rates most in accordance with those in our study; 5.6% for plate fixation and 8.3% for percutaneous pinning [11]. A recent Cochrane systematic review of percutaneous pinning in the treatment of DRFs in adults [13], pooled data from 21 RCTs and 5 quasi-RCTs comparing either pinning with cast immobilization, different pinning techniques, or immobilization regimes for displaced or unstable DRFs in a total of 1946 patients, with regard to short-, medium-and long-termpatient-reported outcomes and complications. They reported an SSI rate of 7.7% (ranging from 0 to 15%) in the 285 patients treated with percutaneous pinning.…”

Section: Ssi Ratesrelation To Previous Researchsupporting

confidence: 84%

“…A recent Cochrane systematic review of percutaneous pinning in the treatment of DRFs in adults [ 13 ], pooled data from 21 RCTs and 5 quasi-RCTs comparing either pinning with cast immobilization, different pinning techniques, or immobilization regimes for displaced or unstable DRFs in a total of 1946 patients, with regard to short-, medium- and long-termpatient-reported outcomes and complications. They reported an SSI rate of 7.7% (ranging from 0 to 15%) in the 285 patients treated with percutaneous pinning.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, the NCSP-S code for percutaneous pinning does not discriminate between pins buried under the skin or not, which also may have introduced bias. However, a recent Cochrane review of percutaneous pinning in the treatment of DRFs found very low-quality evidence that buried pins reduce the incidence of superficial SSIs [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have compared surgical methods for displaced DRFs with regard to functional, radiographic and patient-reported outcome measures in a variety of settings and patient groups. While long-term functional and patient-reported outcomes have been shown to be similar between the most frequently used surgical methods [8][9][10][11][12][13][14], the spectrum and frequency of associated complications vary considerably [15][16][17]. It is therefore paramount that physicians treating patients with a displaced DRF are familiar with the complications associated with each treatment method in order to achieve the most favorable outcome.…”

Section: Introductionmentioning

confidence: 99%

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Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients

Rundgren

Enocson

Järnbert-Pettersson

et al. 2020

BMC Musculoskelet Disord

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Background Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. Methods We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0–8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. Results A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2–7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4–3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI. Conclusions The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for estimating the likelihood of SSI in individual patients.

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Section: Ssi Ratesrelation To Previous Researchsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients

Rundgren

Enocson

Järnbert-Pettersson

et al. 2020

BMC Musculoskelet Disord

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“…Pin tract infection (PTI) was reported to be a common complication in the EF and KW [25,26], however, all PTI resolved uneventfully with oral antibiotics. The incidence of tendon irritation was higher in the KW because the procedure was performed in percutaneous fashion, whereas the EF was performed using a small incision exposing the bone.…”

Section: Discussionmentioning

confidence: 99%

Fixation of delayed distal radial fracture involving metaphyseal diaphyseal junction in adolescents: a comparative study of crossed Kirschner-wiring and non-bridging external fixator

Rai

Tang

et al. 2020

BMC Musculoskelet Disord

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Background: Conservative treatment remains the preferred choice for distal radius fracture in children. However, loss of reduction is problematic, especially in an older child. Crossed Kirschner-wires is widely used to treat distal radius fracture in adolescents. This study aimed to compare the application of crossed Kirschner-wiring (KW) and non-bridging external fixator (EF) for the treatment of delayed distal radial fracture involving metaphyseal diaphyseal junction (MDJ) in adolescents. Methods: Between January 2012 to January 2017, 146 (male = 101, female = 45) patients in EF group and 117 (male = 76, female = 41) in KW group, were reviewed retrospectively. Preoperative data were collected from the hospital database, and postoperative clinical outcomes data were collected during the follow-up visits. We used SPSS for data analysis. Results: There existed no significant difference between EF and KW regarding sex, body weight, fracture side, duration from injury to surgery. The duration of surgery was significantly shorter in EF (30.5 ± 6.1 min) than the KW group (44.6 ± 9.4 min), P < 0.001. The number of intraoperative X-ray images was significantly lower in EF (6.5 ± 1.1) than KW (11.8 ± 2.3), P < 0.001. The incidence of tendon irritation is significantly higher in the KW (19.7%) than the EF group (0%), P < 0.001. The residual angulation on the AP view was higher in KW (3.8 ± 2.3, degrees) than the EF group (2.5 ± 1.6, degrees), P < 0.001. The volar tilting is better in EF (6.6 ± 1.1, degrees) than the KW group (1.0 ± 1.5, degrees), P < 0.001. However, the functional outcomes of the wrist showed no significant difference between EF and KW group, P = 0.086. Conclusion: The EF was superior to KW in the treatment of radial MDJ fractures in adolescents. The EF displayed shorter duration of surgery, less tendon irritation, and better radiographic outcomes than the KW. However, the cost-effect analysis remains to be investigated, because the EF is more expensive than KW.

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Surgical fixation of the adult distal radius fracture: when and why?

Chan¹,

Lipscombe²

2021

Orthopaedics and Trauma

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Percutaneous pinning for treating distal radial fractures in adults

Abstract: Editorial group: Cochrane Bone, Joint and Muscle Trauma Group Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 2, 2020.

Cited by 18 publications

References 74 publications

Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients

Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients

Fixation of delayed distal radial fracture involving metaphyseal diaphyseal junction in adolescents: a comparative study of crossed Kirschner-wiring and non-bridging external fixator

Surgical fixation of the adult distal radius fracture: when and why?

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