1 Closed Reduction and Percutaneous Pin Fixation of Distal Radius Fractures

• Close reduce fracture. Check reduction with intraoperative radiograph.
  
• If fracture reduced:
  
  
  
  1. Create 1 to 2 cm incision centered over the radial aspect of the radial styloid (Fig. 1-1).
     
  2. Identify and protect sensory nerves. Expose the radial styloid dorsal to the tendons of the first extensor compartment (Fig. 1-2).
     
  3. Insert two or more 0.062 in. wires across fracture fragments (Fig. 1-3A,B). Make a small incision over fragments that will be pinned via a dorsal approach. Retract and protect the extensor tendons.
  
  
• If fracture not reduced after attempted closed reduction:
  
  
  
  1. Use fluoroscopy to localize the fracture on a lateral projection.
     
  2. On AP projection localize two points along the fracture line: one beneath the scaphoid(S) fossa, the second beneath the lunate(L) fossa. Make two 1 cm incisions at these points.
     
  3. Spread through incisions to dorsal cortex with curved hemostat.
     
  4. Insert, without power assist, 0.062 in. wires into the fracture site to, but not through, the palmar cortex. Verify position with fluoroscopy (Fig. 1-4).
     
  5. Place wire driver on wire and move driver distally until pin is ~45 degrees to the long axis of the radius (Fig. 1-5). Check reduction with fluoroscopy Advance pin through palmar cortex (Fig. 1-6). Place second pin in similar fashion.
     
  6. Augment dorsally placed pins with two 0.062 in. pins inserted through the radial styloid (Fig. 1-3A).

Related posts:

Intra-articular Fractures of the Distal Radius Treated with Dorsal Plate Nonunion of an Ulnar Neck Fracture Percutaneous Screw Fixation of Scaphoid Fractures Flexor Carpi Radialis Tendon Stabilization of the Scapholunate Joint (Brunelli Procedure) Closed Reduction and Internal Fixation of Bennett’s or Rolando’s Fractures Capitate Shortening with Capitohamate Fusion

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