In older people, a 'broken wrist' (from a fracture at the lower end of one of the two forearm bones) can result from a fall onto an outstretched hand. Treatment usually involves reduction (putting the broken bone back into position) and immobilising the wrist in a plaster cast. Surgery may be considered for more seriously displaced fractures. One type of surgery is percutaneous pinning. This involves the insertion of pins through the skin (percutaneous) to hold the bones in a proper position while they heal. In most pinning methods, wires are placed across the fracture and used to fix the fragments together. In Kapandji pinning, the wires are placed to support the distal (lower end) fragment. This review looked at the evidence from randomised controlled trials testing the use of percutaneous pinning or comparing different aspects of percutaneous pinning.
Thirteen trials, involving 940 generally older adults with potentially or evidently unstable fractures, were included. Because of weak methodology such as using inadequate methods of randomisation and outcome assessment, the possibility of serious bias cannot be ruled out.
Six trials compared percutaneous pinning with plaster cast immobilisation. Pinning involving across-fracture fixation, used in five of these trials, improved anatomical outcome; and in three trials it appeared to improve function too. The complications associated with across-fracture fixation were generally minor. Kapandji pinning, used in the remaining trial, was associated with an excess of complications compared with conservative treatment. Three other trials compared different methods of pinning. Two of these found some evidence of an increased complication rate with Kapandji pinning compared with across-fracture methods. Two trials using two very different pinning techniques compared biodegradable (dissolvable) pins or wires versus metal pins or wires. Both trials found a significant excess of complications associated with the use of the biodegradable material. Two trials compared plaster cast immobilisation for one week versus for six weeks after surgery. One of these trials found the duration of immobilisation after across-fracture pinning did not have a significant effect on outcome. In contrast, more complications occurred in the early mobilisation group after Kapandji pinning in the other trial.
The review concluded that there is some evidence to support the use of percutaneous pinning. However, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use.