Introduction
The development of knowledge about a variety of orthopaedic trauma diseases can be seen in the history of distal radius fractures. Prior to Petit, Pouteau, and Colles, it was thought that a dislocation of the distal radio-ulnar joint (DRUJ) or a carpal injury was the underlying nature of distal radial injury. After writing his thoughts in "On the Fractures of the Carpal Extremity of the Radius" in 1814, Abraham Colles became the first author to describe distal radius fractures in English literature. [1]
Although 20% of all fractures treated in emergency rooms are distal radial fractures, many are not "totally exempt from discomfort" following treatment. More than 1000 peer-reviewed papers have been published on the topic over the previous few decades, yet there is no agreement on the best treatment. The extent to which the anatomy is restored, the quality of the bone, the development of new techniques and devices, the experience and skill of the surgeon, and the results in older populations are just a few of the many confounding factors that exist. [2] The early technique of cast immobilisation and closed reduction has led to malunion, rigid joints, and deformity. By interfering with the extrinsic hand musculature's mechanical advantage, it has a negative impact on how the wrist and hand work. [3-5] Radius collapse and DRUJ subluxation are frequently caused by closed reduction and POP immobility. [6]
One of the first methods of fixation, percutaneous pinning adds more stability. Depalma described a 45° angle in ulno-radial pinning. [7] Stein recommends adding a second, 2-mm dorsal K-wire with radio-ulnar pinning. [8] Raycheck advised ulno-radial pinning in addition to the fixation of the DRUJ, while Kapandji described double intrafocal pinning into the fracture surface using 2-mm K-wires. [10]
Ligamentotaxis and joint-spanning external fixation immediately neutralize the axial load over the radius and minimize the impacted articular fragments indirectly. [11] For unstable intra-articular fractures, Ruch and Ginn, Schumr, and numerous others described open reduction and internal fixation of the distal radius. [12] Doi at al provided an explanation of arthroscopically guided fracture reduction. [13] Therefore, this study evaluates the functional and radiological outcomes of distal radius fractures treated by percutaneous pinning in ulno-carpal joint and distal radius.
Methodology
The present study was conducted at the department of orthopaedics, N.S.C.B. Medical College and hospital, Jabalpur (M.P.), after obtaining informed and written consent from the study subjects. Study Design was prospective interventional and study period was from 1st March 2021 to 31st June 2022. Study Population was all the patient attending OPD and casualty of Orthopaedic department with diagnosed distal radius fracture. Convenient sampling method was used and sample size was of 50 patients.
The adequate required sample size was estimated using following formula:
n = z2pq / d2, where –
n = sample size
z = 1.96 (considering 0.05 alpha, 95% confidence limits and 80%beta) p = assumed probability of occurrence or concordance of results
q = 1 –p; and d = marginal error (precession)
Inclusion Criteria was patients with fracture of the distal radius (comminuted extra-articular and intraarticular), patients age is of over 55years and fracture should be operated within 14 days of trauma. Exclusion Criteria was fractures which require open reduction, pathological fractures are ruled out and if there is evidence that the patient will be unable to adhere to trial procedures or complete questionnaires, such as in cognitive impairment.
Base line data collection done by radiological, Biochemical and pathological investigations like X-ray forearm with wrist joint true anteroposterior view and lateral view, complete blood counts, random blood Sugar, serum Uric Acid, serum Creatinine, Liver function tests: SGOT, SGPT, ESR, CRP, Chest X Ray and ECG and HIV/HBsAg/HCV.
The patient was positioned supine on the OT table, with the limb on a side table. Under Regional Anaesthesia (If unsuccessful then it was converted to General Anaesthesia at the discretion of the anaesthetist), the parts were painted and draped.
The fracture alignment was achieved by traction – counter traction, and the reduction confirmed by the image intensifier. 1.5- or 2-mm k-wires were passed from the radius styloid crossing the fracture site obliquely to exit the dorso-ulnar cortex of the radius shaft.
Another K-wire was passed from the dorso-ulnar aspect of the distal radius between the 4th and 5th extensor compartments and directed to engage the volar radius cortex of the proximal fragment. The exposed ends of the K-wires were then either bent or the ends were inserted into metal balls. The pin sites were then dressed. Then a below elbow slab was applied on the volar surface with the wrist in neutral position.
The limb was raised for 3 days after surgery. After anesthetic wore off, the patient was urged to move his fingers. Three days later, patient allowed to move elbow. Inspection and dressing of pin locations was done.
The patient was discharged, if pin sites and mobilization were good. Weekly pin site inspection and follow-up was required. At four weeks, the pins and slab were withdrawn if there were sufficient symptoms of union, and the patient was given a crepe bandage. Patient was told to gently move his wrist at home. If the union wasn't adequate after four weeks, the patient was observed at five and six weeks. After removing the k-wires, the patient was instructed to move his wrist. No cases showed insufficient union at 6 weeks.
