4-Pin Technique of Management of Distal Both Bone Fracture of Forearm in Elderly

Abstract:
Introduction: Distal both bone fractures are one of the most common injury of an elderly who falls with flexed elbow, landing on the wrist. There is a wide variety of treatment options such as closed reduction and POP cast,internal fixation, external fixation and percutaneous pin fixation in many configurations to treat both bone fracture of forearm however the comorbidity of the elderly precludes the methods of internal fixation in many situations. Hence we devised a novel percutaneous 4 pin configuration of K wires for management of distal both bone fractures of the elderly, where closed reduction is possible, and the ulna is re-onstructible. This study reports the outcomes of this technique. Methods: All patients who are more than age of 50 and who presented with distal both bone fracture during the period of 3 years Jan 2015 toDec 2017 managed were included in the study. They are managed by closed reduction and 4-pin fixation and were evaluated for complications including wire loosening and infection,
tendon or nerve injury, reflex sympathetic dystrophy and functional outcome.Results: A total of 49 consecutive patients with 50 distal both bone fractures were treated in the study period with a mean age of 55.4 years; 67% were female and 59% were due to domestic falls. After death from unrelated causes and loss to follow-up, 42 patients were reviewed and clinical outcome was evaluated using Cooney’s modification of Green and O’Brien’s score. All fractures healed and 84.2% had an ‘excellent’
outcome and 13.6% were ‘good’; only one patients achieved a ‘fair’ outcome, who had highly comminutedfracture. Complications were limited and temporary with no cases of deep infection, tendon or nerve injury or reflex sympathetic dystrophy.
Conclusions: This study proved that our novel customised 4-pin percutaneous fixation was sufficiently stable and controlled all fragments of distal both bone fractures effectively to allow early mobilisations to prevent stiffness with excellent functional outcomes.