Distal Radius Fracture, a Comparison Between Closed Reduction and Long Arm Cast Vs. Closed Reduction and Percutaneous Pinning and Short Arm Cast

Distal radius fracture represent approximately one-sixth of all fractures treated in emergency departments. According to high incidence rate, different mechanisms of injury and new treatments for this fracture, it is becoming one of the most challenging of all kinds of fractures. to compare treatment outcome of traditional cast immobilization versus modern percutaneous pinning procedure in patients with distal radius fractures. In this randomized clinical trial study, 198 patients with "displaced but stable distal radius fracture without joint incongruity", were split into two groups and each group was treated by one of the following standard protocols: A- Closed reduction + Long arm cast; B- Closed reduction and Percutaneous pinning and Short arm cast. The patients were followed up after operation for three months from the point of view of: 1- satisfaction(based on Saito chart) 2-Loss of Reduction 3- Finger stiffness 4- Pin tract infection and 5-The mean of post operation follow up visits. For statistical analysis the Fisher's exact test and chi-square test were used by SPSS software16 In group A, six cases of loss of reduction were detected in the first week who were treated by re-reduction and P.C pinning procedure; But no cases of loss of reduction were diagnosed in group B. Satisfaction percentage for Excellent value was 81.8% in group A and 93.9% in group B (p= 0.131). Finger stiffness incidence rate in group B was meaningfully lower than group A (p=0.039). Pin tract infection incidence rate was 15.1% in group B; all of them were treated by pin removal and oral antibiotic therapy. The mean of post operation visits was 4.4 in group B and 3.6 in group A out of five sessions (p<0.0001). It seems that closed reduction and P.C pinning is a safer and less complicated procedure, especially in decreasing finger stiffness in these fractures.