A Comparative Study of Radiological, Functional, and Clinical Outcomes of Three-Pin Versus Five-Pin Techniques for Distal Radius Fracture Fixation

TL;DR

This study compares three-pin and five-pin techniques for fixing wrist fractures, finding that five pins offer better bone alignment but more complications.

Contribution

A novel comparative analysis of three-pin versus five-pin fixation techniques for distal radius fractures, focusing on radiological, functional, and complication outcomes.

Findings

Five-pin fixation preserved volar tilt and radial height better than three-pin fixation.

Five-pin fixation had a higher rate of pin tract infections and patient discomfort.

No significant difference in functional outcomes between the two techniques.

Abstract

Introduction

Distal radius fractures are among the most frequently encountered injuries in orthopedic practice, and their optimal management remains a topic of considerable debate. Percutaneous pinning with Kirschner wires (K-wires) is a widely accepted treatment modality, valued for its minimal invasiveness and cost-effectiveness. However, the ideal number and configuration of pins required to balance fracture stability with potential complications is unclear. This study aims to compare the radiological, functional, and clinical outcomes of three-pin versus five-pin fixation techniques for distal radius fractures.

Methodology

This was a single-center, prospective comparative observational study conducted over a six-month period involving 70 patients with distal radius fractures meeting the inclusion criteria. Patients were allocated to two groups: Group A (n=35) received three-pin fixation, and Group B (n=35) received five-pin fixation. The primary objective was to compare radiological outcomes (radial height, radial inclination, volar tilt), functional outcomes using the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the incidence of complications such as pin tract infection and loosening over a three-month follow-up period.

Results

At the three-month follow-up, the five-pin fixation group demonstrated statistically significant superiority in maintaining radiological parameters, with better preservation of volar tilt (mean 8.2° vs. 5.1°, p=0.04) and radial height (mean 10.5 mm vs. 8.9 mm, p=0.03). However, this radiological advantage did not translate into a statistically significant difference in functional outcomes, as measured by the mean DASH score (14.8 in the three-pin group vs. 13.5 in the five-pin group, p=0.35). Critically, the five-pin group experienced a significantly higher rate of pin tract infections (22.8% vs. 8.5%, p=0.048) and patient-reported discomfort.

Conclusion

The five-pin fixation technique provides enhanced biomechanical stability, resulting in superior maintenance of anatomical reduction in distal radius fractures. However, this benefit is offset by a higher risk of pin-related complications without a corresponding improvement in short-term functional outcomes. The choice between a three-pin and a five-pin construct should be tailored to the individual fracture pattern and patient factors, carefully weighing the need for stability against the risk of iatrogenic complications.

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