# Outcomes of Fluoroscopy-Free Percutaneous Intrafocal Pinning for Adult Distal Radius Fractures in a Resource-Limited Setting in South Kivu, Democratic Republic of the Congo

## TL;DR

This study shows that a technique for fixing wrist fractures without X-ray imaging works well in a low-resource area of the Democratic Republic of the Congo.

## Contribution

The study demonstrates the effectiveness of fluoroscopy-free treatment for wrist fractures in resource-limited settings.

## Key findings

- Most patients had excellent or good outcomes in terms of anatomy, radiology, and function.
- Complications were rare and included infections, pin migration, and nerve injuries.
- Longer rehabilitation and hospitalization were linked to worse outcomes.

## Abstract

Purpose: To assess the anatomical, radiological, and functional outcomes of fluoroscopy-free percutaneous intrafocal pinning for distal radius fractures in adults in resource-constrained settings of South Kivu, Democratic Republic of Congo.

Methods: In a prospective, multicenter, interventional study, 101 adults with distal radius fractures were treated from January 2018 to December 2023 across four hospitals. Fractures were reduced using external maneuvers and stabilized with three-pin percutaneous intrafocal pinning without fluoroscopy. Outcomes were evaluated using the Grumillier Criteria and modified Castaing classification, with a minimum six-month follow-up. Data analysis with R software (R Foundation for Statistical Computing, Vienna, Austria) included descriptive statistics, principal component analysis, and factorial analysis.

Results: Patients had a mean age of 36.41 ± 12.61 years (range: 18-70). Castaing type I fractures comprised 92.08% of cases, with types 2 and 4 each at 2.97%. Consolidation occurred at a mean of 46.82 ± 4.67 days. Complications included superficial infections (three cases), callus formation (three cases), pin migration (two cases), algodystrophy (one case), twisted pin (one case), radial sensory branch injury (one case), and thumb extensor tendon injury (one case). At a mean follow-up of 27.27 ± 11.85 months, subjective outcomes were very good in 84.16% and good in 9.90%; objective outcomes were very good in 77.23% and good in 16.83%; and radiological outcomes were very good in 75.25% and good in 19.80%. Longer rehabilitation correlated with poorer scores, while extended hospitalization was associated with worse objective outcomes. Socio-professional reintegration was reduced with poor objective scores. Age and gender had no impact on outcomes.

Conclusion: Fluoroscopy-free percutaneous intrafocal pinning is a safe and effective technique for managing distal radius fractures in low-resource settings. It delivers excellent anatomical, radiological, and functional results.