Percutaneous elastic-dynamic fixation for the treatment of volar displaced distal radius fractures. A solution for elderly patients?

Aim The Epibloc elastic-dynamic fixation has been applied for many years at several hand surgery centres in Italy. This technique has been considered safe and reliable in the treatment of distal meta-epiphyseal fractures of the radius with dorsal displacement. The aim of this study was to evaluate an alternative use of this method in the treatment of volar displaced wrist fractures in cases where an internal fixation could not be recommended. Methods The procedure consisted of two flexible pins with a trocar tip and an external plate for locking fixation with compression. The surgical technique was derived from the original procedure, modifying the placement of the pins and performing small surgical accesses to preserve the neuro-vascular structures of the volar aspect of the wrist. To achieve and preserve the reduction of the volar fragment, a third pin was inserted into the fracture with a similar procedure to Kapandji's reduction technique. Results At three-month follow-up, most patients did not experience any pain. In 14 cases, the strength grip was recovered between 75% and 90%, compared to the contralateral hand (Jamar test). In 15 patients, the wrist range of motion was restored with values greater than 100. In 17 cases, forearm pronation-supination was restored to more than 120°. Conclusion In cases of non-comminuted, one or two fragments volar displaced wrist fractures, the elastic-dynamic fixation associated with an intrafocal pinning reduction may be proposed as an alternative to open reduction and internal fixation in elderly patients.