A novel retractor-assisted closed reduction combined with percutaneous pinning fixation for the treatment of elderly distal radius fractures: a retrospective cohort study

Background Percutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures. Methods From March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation. Results All the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33±1.74 mm; the first follow-up, 13.27±1.81mm; last follow-up, 13.16±1.76mm) and ulnar variance (postoperative, −0.10±1.29mm; the first follow-up, −0.05±1.27mm; last follow-up, −0.12±1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94±5.21%), radial deviation (90.69±6.01%), and supination (90.25±5.87%); ulnar deviation (89.81±5.82%) and QuickDASH score (2.70±3.64); and grip strength (92.50±5.59%), pronation (90.50±6.04%), and modified Mayo wrist score (90.94±4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up. Conclusion S-PCP improves fracture reduction and wrist function and can serve as an effective method for A2(AO/OTA) and A3 type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.

Comparison of Bending Strength among Plate, Steinmann Pin, and Headless Compression Screw Fixations for Proximal Ulnar Shaft Fracture in Sawbones

Purpose: Although plate osteosynthesis is commonly used to treat proximal ulna fracture, its treatment method is controversial because of complications such as large incision, long operation time, and soft tissue injury. Therefore, intramedullary headless compression screw (HCS) and Steinmann pin are considered as alternative treatment options. In this study, we aim to compare bending strength of plate and cortical screws, HCS, and Steinmann pin for proximal ulnar shaft fracture with sawbone. Methods: Transverse type fractures were made intentionally at the distal 7 cm from the proximal end of ulna sawbones and fixated with plate, HCS, and Steinmann pin after reduction. Three-point bending tests were performed with total of 21 sawbones, seven pieces for each group. Results: Average ultimate bending strength for each group was as follows; 521.7N for plate fixation group, 706.4N for HCS fixation group, and 812.6N for Steinmann pin fixation group. Statistically significant results were observed among the three groups (p<0.01). When two groups were compared separately, Steinmann pin fixation and plate fixation (p<0.01), Steinmann pin and HCS fixation (p=0.047) showed statistical significance. There was a significant trend between HCS and plate fixation group (p=0.064).Conclusion: HCS and Steinmann pin fixation showed higher bending strength when compared to plate fixation for proximal ulnar shaft fracture in sawbone. Although further studies are needed, HCS and Steinmann pin fixation are promising fixation methods that may be used as an alternative to plate fixation.

Steinmann pin retractor-assisted reduction with circle plate fixation via sinus tarsi approach for intra-articular calcaneal fractures: a retrospective cohort study

Background Sinus tarsi approach and mini-calc plate have been used for intra-articular calcaneal fractures. However, the sinus tarsi approach has limited exposure to the lateral wall, which makes it challenging to obtain an excellent anatomic reduction of the calcaneal body. What is more! To restore the width of the calcaneal body entirely and prevent the heel varus simultaneously with mini-calc plate was tough as well. Aimed to solve the aforementioned problems, our study focused on using the Steinmann pin retractor for reduction and the circle plate for fixation via the sinus tarsi approach. Methods From March 2017 to January 2019, 15 patients with closed calcaneal fractures were treated with the method of Steinmann pin retractor-assisted reduction and circle plate fixation via the sinus tarsi approach. All these patients received a positive postoperative clinical and radiological evaluation. Results A postoperative follow-up was done for each of the 15 patients, and the following scores and parameters were observed: value of visual analogue scale (VAS) was 1.44 ± 0.63, and The American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot score was 84.31 ± 5.03 at the last follow-up. The Böhler angle (30.81 ± 3.56°), width (37.83 ± 4.87 mm), length (87.4 ± 3.33 mm), and height (86.23 ± 5.36 mm) of the calcaneus were improved significantly in comparison with preoperative values (− 0.94 ± 10.06°, 45.67 ± 5.68 mm, 82.72 ± 5.54 mm, 76.32 ± 7.98 mm), and these parameters were maintained excellently after 6–19 months’ follow-up. Conclusion Our present study suggested that Steinmann pin retractor-assisted reduction with circle plate fixation via the sinus tarsi approach may serve as a safe and effective method for Sanders type II and type III calcaneus fractures. The Böhler angle, height, length, and body of the calcaneus were excellently restored postoperatively and maintained at last follow-up and rare postoperative complications. Trial registration This study has been registered. The unique identifying number is research registry 5092.

Problem of Pin Breakage in Equine Transfixation Pin Casting: Biomechanical Ex Vivo Testing of Four Different Pins

Objective The aim of this study was to evaluate cyclic fatigue behaviour of a new pin with a thread run-out design in comparison with three other types of pins commonly used for equine transfixation pin casting. Materials and Methods Twenty-four pairs of equine cadaveric third metacarpal bones (MC3) equipped with one transfixation pin placed horizontally in the distal metaphysis were tested using a simplified model, mimicking the biomechanical situation of equine transfixation pin casting. A 6.3/8.0-mm Imex Duraface pin with thread run-out design (ITROP) was compared with a 6.1-mm smooth Steinmann pin (SSP), a Securos 6.2-mm, positive-profile pin (SPPP) and an Imex 6.3-mm, positive-profile pin (IPPP) under cyclic loading until failure in axial compression of MC3. Results All pins broke at clinically relevant load levels and cycle numbers. The SSP endured significantly (p = 0.0025) more cycles before failure (mean: 48685) than the ITROP (mean 25889). No significant differences in cycles to failure were observed comparing the SPPP versus ITROP, and the IPPP versus ITROP, respectively. Clinical Significance A thread run-out design does not necessarily lead to higher resistance against pin breakage under cyclic loading conditions. The SSP was most resistant against cyclic failure in these testing conditions, even though it was associated with more lateromedial displacement and cortical wear-out. This could outweigh reported disadvantages of the SSP such as reduced resistance to axial extraction and pin loosening.