INTRAFOCAL (KAPANDJI) PINNING OF UNSTABLE DISTAL RADIUS FRACTURES - APRELIMINARY-REPORT

Seventeen consecutive patients (17 wrists) who underwent intrafocal pi nning of unstable distal radius fractures, as described by Kapandji, w ere retrospectively reviewed at a mean of 42 weeks after surgery (rang e, 13-88 weeks). The patients were immobilized for 6 weeks postoperati vely. All patients were assessed by a single physician and were asked a set of questions regarding subjective and functional status. All pat ients underwent physical examination of their upper extremities, and b ilateral wrist PA and lateral x-rays were taken. There were 13 females and four males; the average age was 49 years. Ten dominant and seven nondominant extremities were involved. Average volar tilt on follow-up lateral wrist radiography was 7 degrees. This compares with -20 degre es at initial presentation, -12 degrees preoperatively, 6 degrees imme diately postoperatively, and 10 degrees in the normal wrists. Radial s hortening (average) was -2 mm at initial presentation, -1 mm preoperat ively, 1 mm postoperatively, 0 mm at follow-up, and 1 mm in the normal wrists. Radial inclination was 17 degrees initially, 20 degrees preop eratively, 23 degrees immediately postoperatively, 23 degrees on follo w-up, and 24 degrees in the normal wrists.There was a trend for patien ts with osteopenic bone to lose their postoperative reduction. However , this was not statistically significant. Patients older than 65 years of age had significantly inferior radiologic results. Loss of pronati on and supination averaged 2 degrees (range 0-10 degrees) compared wit h the uninjured wrist. Loss of dorsiflexion averaged 6.5 degrees, and palmar flexion averaged 7.6 degrees. The patients' subjective complain ts were minimal. Average pain on visual analog scale (VAS) was 0.44/10 . Function measured 8.64/10 (VAS). Sixteen of the patients were happy with the surgery and the outcome of their wrists. Complications includ ed extensor tendon rupture (one patient), pin migration requiring prem ature removal (one patient), and initial loss of reduction requiring r eoperation (one patient). Intrafocal pinning of unstable distal radius fractures provides an effective means to stabilize these complex inju ries. Early follow-up suggests that the patients have a satisfactory f unctional outcome. The complications in this series were preventable, Intrafocal pinning should be added to the surgical armamentarium in tr eating distal radius fractures.