Percutaneous pinning for treating distal radial fractures in adults.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2020;8(6):6 Cochrane Database Syst Rev. 2020 Feb 7;2:CD006080.What this means for my practice?
The results of this meta-analysis suggest that percutaneous pinning may result in a lower risk of complications requiring secondary treatment and a lower risk of finger stiffness, with more favourable functional outcomes, compared to a plaster cast. However compared to plaster casting, percutaneous pinning results in an increased risk of pinning-related complications such as wire migration and pin track infection. Variations in pinning method may further affect the risk of complications. Given the very low quality of the available evidence, caution must be taken when interpreting the results and a future high-quality trial is needed.
Study Summary
Twenty-six studies including 1946 patients were included in this meta-analysis comparing percutaneous pinning and plaster casting for the treatment of distal radius fracture. Additionally, variations of the percutaneous pinning procedure, including various pinning devices and post-operative rehabilitation programs, were reviewed. The primary outcomes of interest were patient-reported functional outcomes and the risk of complications. Radiographic, economic, grip strength, range of motion, pain, patient satisfaction and physician-reported outcomes could not be pooled due to incomplete data, lack of reporting or uncertainties in the data. Results of the study found that the risk of fracture redisplacement requiring secondary treatment and the risk of finger stiffness was significantly lower in the percutaneous pinning group compared to the plaster cast group. The risk of a fair to poor composite functional grading score was significantly lower in the percutaneous pinning group. Significant differences in wire displacement were observed between Kapandji and Py's isoelastic percutaneous pinning methods, in favour of Py's pinning. No significant differences in the risk of complications were observed between percutaneous wire patients who received early mobilization and later mobilization post-surgery.
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