Is percutaneous pinning needed for the treatment of displaced distal radius metaphyseal fractures in children?

Abstract

Background:Distal radius metaphyseal (DRM) fractures are very frequent childhood fractures. Whether additional percutaneous pinning improves the outcome remains controversial. In this review, we tried to systematically evaluate the effect of percutaneous pinning on re-displacement, secondary reduction, radiographs, function, and complications in children with displaced DRM fractures.Methods:PubMed, Medline, Embase, Cochrane Library, and Web of Science databases were explored systematically to identify randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing cast immobilization alone or following reduction to additional percutaneous pinning in the treatment of pediatric displaced DRM fractures. Two reviewers independently screened eligible articles and extracted relevant information from each article. The methodological quality of eligible articles was evaluated using the Cochrane Collaboration risk assessment tool (RCTs) and modified Jadad scale (CCTs).Results:A total of 4 RCTs and 3 CCTs met the inclusion criteria, with a total patient count of 1144 children. The results showed that additional percutaneous pinning significantly reduced the rate of re-placement (Chi-square tests, P < .001) and complications (Chi-square tests, P = .030). The superior results, both radiographically and functionally seemed to be temporary. No difference was found between the 2 groups after longer-term follow-up.Conclusions:This systematic review suggested that compared with casting following reduction, percutaneous pinning had a positive effect on maintaining the initial reduction and reducing fracture complication rate of displaced DRM fractures in children, but with no significant improvement in function and radiographic outcome at the long-term follow-up. We suggest clinicians think twice before percutaneous pinning of displaced pediatric DRM fractures.

Comparison of Complication Rates, Fluoroscopy Exposure Time, and Functional Results of Two K-wire Fixation Methods in Distal Radius Fractures in Pediatric Patients: Could Mini-incision Technique Feasible for Orthopedic Surgeons?

“…In a systematic review, the mean re-displacement rate was reported 40% in the casting group and 3.6% in the pinning group [11]. K-wire xation of displaced distal radius fractures in children reduced their predicted failure rate from 14-60% was reported by Choi et al [10].…”

“…Although the advantages of K-wires are known, there are some complications related to K-wires which were reported in literatures [11,12]. In some studies, pining complication rates were varying from 0-38% (median 8.3%) [5].…”

“…The completely displaced distal radius fractures are very unstable because of the distruption of both cortices. Because of the signi cant risk for re-displacement, it is advocated immediate K-wire placement is an effective method in completely displaced distal radius fractures of children [4,5,7,10,11]. Although good results have been reported with K-wire xation, super cial infection, neuropraxia, tendon irritation, pull out of wire, subcutaneous K-wires, and prominent scars have been reported as complications after pinning [11][12][13].…”

“…Because of the signi cant risk for re-displacement, it is advocated immediate K-wire placement is an effective method in completely displaced distal radius fractures of children [4,5,7,10,11]. Although good results have been reported with K-wire xation, super cial infection, neuropraxia, tendon irritation, pull out of wire, subcutaneous K-wires, and prominent scars have been reported as complications after pinning [11][12][13]. In the conventional pinning technique, K-wire is inserted just proximal or through the distal radial physis and trans xed across the fracture site [14,15].…”

Is there a reason to challenge our current practice in children’s forearm fractures?

“…Sometimes practice variation occurs even when high-quality evidence exists (Grove et al 2016 , Lohmander et al 2016 ). For the fractures discussed here, there are no published low-risk-of-bias comparative trials that have compared cast-only treatment with closed reduction alone, or closed reduction and percutaneous fixation (Handoll et al 2018 , Zeng et al 2018 ). Evidence from such trials would be helpful, and would need to cover the “grey zone” where most practice variation is likely to occur.…”