In this study, we found the mini-open technique effective in pediatric distal radius fracture with a lower complication rate than percutanous application. Besides this, we also confirm that stabilization with K-wires are effective to prevent re-displacement in the displaced distal radius fracture of children.
In a systematic review, the mean re-displacement rate was reported 40% in the casting group and 3.6% in the pinning group . K-wire fixation of displaced distal radius fractures in children reduced their predicted failure rate from 14–60% was reported by Choi et al. . Leemput et al was reported a high rate of displacement (45.8%) after reduction and cast immobilisation and no redisplacement after reduction and pinning . In a prospective study, Miller et al. reported 39% of patients treated with casting had re-displacement, contrarily none of the patients treated with pin fixation in pediatric patients with distal metaphyseal fractures . As it can be understood from the results, K-wire fixation is recommended by some surgeons for preventing re-displacement [9, 10]. In this study, our re-displacement rates were 10% in K-wire fixation percutaneously and 4% in K-wire with mini-open group respectively and it was significantly lower in mini-open group.
Although the advantages of K-wires are known, there are some complications related to K-wires which were reported in literatures [11, 12]. In some studies, pining complication rates were varying from 0–38% (median 8.3%) . The complications were loss of reduction, prominent scar, infection, pin migration, tendon irritation, transient neuropraxia, failed insertion, subcutaneous K-wires [12, 22, 23]. The reported complications were all classed as minör nevertheless there are technical challenges in the pining of these fractures such as the presence of the physis, the small size of the bone, and the required obliquity of the wire .
McLauchlan et al. stated 2.8% pain, 5.7% prominent scar, and 2,8% pin migration after percutaneous K-wire stabilization in their study population . In another study, Miller et al. reported K-wire complications included pin migration 12.5%, pin-site infection 12.5%, transient neuropraxia of radial nerve 6.2%, and tendon irritation 6.2% after treatment with percutaneous pin fixation . Finally, in the report of Colaris et al, complications were subcutaneous K-wires 11,4%, re-fractures 4,9%, superficial infections 3.2%, transient neuropraxia 1.6%, failed insertion K- wires 1.6% in the treatment of 61 patients by K-wire stabilization .
In this study, we emphasize using mini-incision in the course of applying K-wire to limit the technical problems and to avoid the complications which could be irritative for the pediatric population. We found significantly lower pin-track infection, subcutaneous wire rates in K-wire fixation using by mini incision group. And also, we didn’t observe potentially serious complications such as neuropraxia, tendon irritation and failed insertion of K-wires, angulation, and pull out of wire.
The function is important because it can affect the quality of children. While it was reported no significant difference between percutaneous pinning and casting concerning for to the range of motion in some literature . Loss of pronation was reported higher in the casting group by Ozcan et al. . Also, in the other study, Colaris et al. reported less limitation in pronation and supination in the percutaneous pinning group . In our study, we observed good functional results in both groups after 18 months follow-up period.
The use of fluoroscopy in closed fixation methods increases the exposure to radiation with its associated risks; therefore, modifying the treatment method when possible has been recommended to minimize exposure [27–29].
Some limitations of the present study need to be addressed. First of all, our study’s the retrospective design and the relatively low number of patients. Secondly, we could not arrange homogenous gender distribution because of our study design, last but not at least, our data collection is not enough to give angulation data at the patients’ at 18th month follow-up visit. Besides limitations, strengths of this study include that patient examination was performed by observers different from the orthopaedic surgeon, surgical procedure was made by the same senior surgeon.