A novel retractor-assisted closed reduction combined with percutaneous pinning fixation for the treatment of elderly distal radius fractures: a retrospective cohort study

Background Percutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures. Methods From March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation. Results All the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33 +/- 1.74 mm; the first follow-up, 13.27 +/- 1.81mm; last follow-up, 13.16 +/- 1.76mm) and ulnar variance (postoperative, -0.10 +/- 1.29mm; the first follow-up, -0.05 +/- 1.27mm; last follow-up, -0.12 +/- 1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94 +/- 5.21%), radial deviation (90.69 +/- 6.01%), and supination (90.25 +/- 5.87%); ulnar deviation (89.81 +/- 5.82%) and QuickDASH score (2.70 +/- 3.64); and grip strength (92.50 +/- 5.59%), pronation (90.50 +/- 6.04%), and modified Mayo wrist score (90.94 +/- 4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up. Conclusion S-PCP improves fracture reduction and wrist function and can serve as an effective method for A(2)(AO/OTA) and A(3) type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.

Automated summary

The study introduced an innovative approach using Steinmann pin retractor-assisted closed reduction combined with percutaneous pinning fixation (S-PCP) for elderly patients with distal radius fractures, showing significant improvement in fracture reduction and wrist function compared to traditional methods, making it effective for certain types of fractures.