ORTHOPAEDICS INTRAFOCAL PINNING FOR DORSALLY … · Kapandji in 1976 [7], has gained large...

INTRODUCTION

Fractures of the distal radius represent about 15% of allfractures seen in the emergency units and departments [1].Different therapeutic methods have been described, andthey all aim at achieving a sustained anatomic reductionand restoring the congruity of both the radio-carpal andradio-ulnar joints [2]. Although all methods intend toregain good functionality of the wrist and upper limb,there is still a lack of consensus regarding the optimaltreatment method [2-6]. The surgical treatment of dorsal-ly displaced distal radius fractures has recently evolvedafter the introduction of new generations of low-profileanatomic locking plates and screws [2]. Among varioussurgical modalities, intrafocal pinning, first described byKapandji in 1976 [7], has gained large popularity, espe-cially in the French literature between 1980 and 2000. Theuse of locking plates has been associated with tremendous

increased costs for healthcare providers [3,8], and this iswhere the cheaper method of intrafocal pinning has anobvious economic advantage. The authors aim at present-ing their experience with this technique in a series ofpatients they treated for dorsally displaced distal radiusfractures between 1994 and 1999.

MATERIAL AND METHODS

Between January 1994 and January 1999, intrafocal pin-ning, known as Kapandji technique, was used by two ofthe authors (RJ and AHC) to treat 138 patients with dor-sally displaced distal radius fractures. Because of the ret-rospective nature of this study, only 56 patients could bereviewed and evaluated at the end of the study. The rea-sons for the dropouts among the remaining 82 patientswere: refusal to present for assessment, inability to con-tact patient, or failure to meet the inclusion criteria. Theinclusion criteria were: distal radius fracture with orwithout fracture of distal ulna or ulnar styloid, dorsaldisplacement, availability of initial and postoperative X-rays, minimal follow-up period of 6 months, and patientavailability to undergo clinical and radiological assess-ment of both wrists at the time of evaluation in May1999. Lack of any one of these criteria, as well as a his-tory of previous wrist fracture of any side, were groundsfor exclusion.

146 Lebanese Medical Journal 2017 • Volume 65 (3)

OORRTTHHOOPPAAEEDDIICCSSINTRAFOCAL PINNING FOR DORSALLY DISPLACED DISTAL RADIUS FRACTURES†

http://www.lebanesemedicaljournal.org/articles/65-3/original4.pdf

Amer Camille ABDALLAH1, Ibrahim HAIDAR1-2, Oussama EL HAJJ1-2, Assad TAHA3

Roger JAWISH1-4, Ali Hassan CHAMSEDDINE1-2

Abdallah AC, Haidar I, El Hajj O, Taha A, Jawish R,Chamseddine AH. Intrafocal pinning for dorsally displaceddistal radius fractures. J Med Liban 2017 ; 65 (3) : 146-156.

Abdallah AC, Haidar I, El Hajj O, Taha A, Jawish R,Chamseddine AH. Embrochage intrafocal des fractures du radiusdistal à déplacement dorsal. J Med Liban 2017 ; 65 (3) : 146-156.

ABSTRACT • Intrafocal pinning of dorsally displaced distalradius fractures, as described by Kapandji in 1976, wasvery popular during the last two decades of the last century.This method has clear economic advantages over othermodern methods of internal fixation such as locking plates.The authors aim at presenting the results of a series of56 patients operated for distal radius fractures between1994 and 1999. All patients were clinically reviewed and radiographically assessed at a mean of 16 monthsfollow-up.

The authors believe that intrafocal pinning remains avaluable method for the treatment of dorsally displacedextra-articular distal radius fractures; however, it should beused with caution in presence of epiphyseal and dorsalmetaphyseal comminution.

Keywords : distal radius fracture; intrafocal pinning; Kapandjitechnique

RÉSUMÉ • L’embrochage intrafocal des fractures de l’extré-mité distale du radius à déplacement dorsal, décrit par Kapandjien 1976, a connu une grande popularité pendant les deux der-nières décennies du siècle dernier. Cette technique présentedes avantages économiques évidents par rapport aux mé-thodes modernes de fixation telle que la plaque verrouillée. Lesauteurs présentent les résultats d’une série de 56 patients trai-tés pour de telles fractures entre 1994 et 1999. Tous les patientsont été cliniquement revus et radiographiquement évalués aurecul moyen de 16 mois.

Pour les auteurs, l’embrochage intrafocal des fracturesextra-articulaires à déplacement dorsal de l’extrémité distaledu radius reste une méthode valable ; cependant elle doit êtreutilisée avec précaution en cas de comminution épiphysaire etmétaphysaire dorsale.

Mots-clés : fracture du radius distal; embrochage intrafocal;technique de Kapandji

†In memory of the late Professor Roger Jawish.From Divisions of Orthopaedics and Trauma Surgery inBeirut, Lebanon: 1Bellevue University Medical Center,Faculty of Medical Sciences, Lebanese University; 2SahelGeneral Hospital - University Medical Center; 3AmericanUniversity of Beirut Medical Center; 4Sacré-Cœur Hospital -University Medical Center.

Corresponding author: Ali Hassan Chamseddine, MD.e-mail: [email protected]

The study included 56 patients aged between 17 and76 years, with a mean of 58 years. There were 23females and 33 males; the right wrist was involved in 26patients and the left one in 30. All patients were treatedwith the same surgical technique, under general or loco-regional anaesthesia, in the supine position with theupper limb on a side table, and the use of a tourniquet.After gentle closed reduction the surgeon faithfully fol-lowed the surgical technique described by Kapandji [7,

9-11], using 3 unthreaded pins 18/10 to 22/10 mm diam-eter. Fluoroscopic C-Arm control was used to assessreduction and appropriate position of pins at the end offixation, and the pins were cut back around 1 cm fromthe dorsal cortex; they were finally buried between thesuperficial layer of the dorsal extensor retinaculum andthe deep layer of the skin at the time of closure. In threepatients, an articulated wrist-spanning external fixatorwas used in addition to pinning (from the radius to the

A. C. ABDALLAH et al. – Intrafocal pinning for distal radius fractures Lebanese Medical Journal 2017 • Volume 65 (3) 147

FIGURE 1. Extra-articular type-2 fracture with dorsal comminution.Preoperative (a, b), postoperative (c, d) and final follow-up radiographs (e, f). Satisfactory radiographic and clinical results.

a

b d f

ec

148 Lebanese Medical Journal 2017 • Volume 65 (3) A. C. ABDALLAH et al. – Intrafocal pinning for distal radius fractures

2nd metacarpal); it was removed at 8 weeks at the sametime as the intrafocal pins. No postoperative immobiliza-tion was used in 24 patients, while a volar splint wasapplied in 19 patients and a circular cast in 10; immobi-lization was removed at 3 weeks postoperatively in all29 patients. Rehabilitation was prescribed only for the 3patients in whom an external fixator was used. In allpatients, the pins were removed at 6 to 8 weeks, underlocal anesthesia.

RESULTS

According to Kapandji classification [12], there were:• 3 type-1 fractures (extra-articular, one epiphyseal fragment, dorsal displacement, no dorsal comminution)• 30 type-2 fractures (Fig. 1) (extra-articular, one epiphy-seal fragment, dorsal displacement, dorsal comminution),• 7 type-3 fractures (articular, 2 fragments, frontal T)• 5 type-4 fractures (Fig. 2) (articular, 2 fragments,

FIGURE 2. Intra-articular type-4 fracture.Preoperative (a, b), postoperative (c, d) and final follow-up radiographs (e, f). Satisfactory radiographic and clinical results.

a

b d f

c e


sagittal T) • 10 type-9 fractures (Fig. 3) (epiphysealcomminution), and finally • 1 type-10 fracture (distalradius and distal ulna, ulnar styloid excluded).

In total, 71.4% of fractures were extra-articular (types1 and 2), 14.2% simple intra-articular (types 3 and 4), and12.5% comminuted intra-articular (type-9). The threefractures treated with additional external fixator were twotype-9 fractures and one type-10.

Patients underwent clinical and radiological assess-

ment of the fractured and uninjured wrist at periodsranging between 6 and 52 months (mean 16 months). Inaddition to fracture healing, radiological assessmentincluded measurements of the radial coronal inclination,the radial sagittal inclination or volar tilt, and the ulnarvariance, as adopted by Kapandji [11].

The values obtained on the immediate postoperative andthe final radiographs of both wrists (the fractured and unin-jured) were recorded, and the differences in the values

FIGURE 3. Intra-articular type-9 fracture.Preoperative (a, b), postoperative (c, d) and final follow-up radiographs (e, f). Satisfactory clinical and radiographic results.

a

b d f

c e


between the fractured and intact sides were also separatelyrecorded. A score ranging from 0 to 3 was given to each oneof these differences (Tables I and II). When any measure-ment indicated a borderline value bestween two scores, theworse score was adopted. A final radiographic score from 0to 9 was given to each patient after adding together thescores of the three measurements. The final radiographicresult for each patient was then classified according to thefinal note obtained by this addition, as shown in Table III.A comparison between immediate postoperative and finalfollow-up radiographic results, according to the fracture’stype, was finally made (Table IV).

Final radiographic assessment showed 30.3% excellent,30.3% good, 25% fair, and 14.2% poor results (Table IV).

Clinical assessment at final follow-up was doneaccording to Gartland and Werley score [13], based onresidual clinical deformity (0-3 points), subjective evalu-ation (0-6 points), objective evaluation (0-5 points), andcomplications including arthritic changes and pain (0-5points), median nerve complication (1-3 points), and poorfingers function (1-2 points). It revealed excellent result(0-2 points) in 37.5% of cases, good (3-8 points) in 34%,fair (9-20 points) in 14.2% and poor (> 20 points) in14.2% (Table V).

TABLE ISCORE ALLOCATED FOR THE RADIOGRAPHIC MEASUREMENTS OF THE RADIAL

CORONAL INCLINATION AND THE RADIAL SAGITTAL INCLINATION OR VOLAR TILT

Difference* D < 5° 5° ≤ D < 10° 10° ≤ D < 15° D ≥ 15°

Score 0 1 2 3

*D: difference in º between the normal & operated side measurements.

TABLE IIITHE FINAL RADIOGRAPHIC SCORE FOR EACH PATIENT IS MADE BY ADDITION

OF THE 3 SCORES PREVIOUSLY DOCUMENTED FOR THE MEASUREMENTS OF THE

RADIAL CORONAL INCLINATION,THE RADIAL VOLAR TILT AND THE ULNAR VARIANCE

Final Radiographic Score 0 1-3 4-6 7-9

Radiographic Result Excellent Good Fair Poor

TABLE IISCORE ALLOCATED FOR THE RADIOGRAPHIC MEASUREMENT OF THE ULNAR VARIANCE

Différence* D<3mm 3mm≤D<6mm 6mm≤D<12mm D≥12mm

Score 0 1 2 3

*D: difference in mm between the normal & operated side measurements.

TABLE IVRADIOGRAPHIC RESULTS ACCORDING TO THE FRACTURE TYPE: IMMEDIATELY POSTOPERATIVE (IPO) AND FINAL FOLLOW-UP (FFU)

Radiographic Excellent Good Fair Poor Totalresult IPO FFU IPO FFU IPO FFU IPO FFU IPO FFU

Fracture type (66%) (30.3%) (19.6%) (30.3%) (10.7%) (25%) (3.5%) (14.2%)

Type 1 3 3 0 0 0 0 0 0 3 3

Type 2 24 12 6 10 0 6 0 2 30 30

Type 3 3 0 3 4 1 2 0 1 7 7

Type 4 2 0 1 1 2 2 0 2 5 5

Type 9 4 2 1 1 3 4 2 3 10 10

Type 10 1 0 0 1 0 0 0 0 1 1

Total 37 17 11 17 6 14 2 8 56 56

TABLE VFINAL RADIOGRAPHIC (RR) AND CLINICAL RESULTS (CR) ACCORDING TO THE FRACTURE TYPE

Radiographic Excellent Good Fair Poor Total

results RR CR RR CR RR CR RR CR RR CRFracture type (30.3%) (37.5%) (30.3%) (34%) (25%) (14.2%) (14.2%) (14.2%) (100%) (100%)

Type 1 3 3 0 0 0 0 0 0 3 3

Type 2 12 16 10 12 6 2 2 0 30 30

Type 3 0 1 4 3 2 1 1 2 7 7

Type 4 0 1 1 2 2 1 2 1 5 5

Type 9 2 0 1 2 4 3 3 5 10 10

Type 10 0 0 1 0 0 1 0 0 1 1

Total 17 21 17 19 14 8 8 8 56 56

& Clinical


Complications occurred in 14 cases (25%) and con-sisted of neuroma of the sensory branch of the radialnerve in 1 patient (1.8%), rupture of the extensor ten-don of the 3rd & 4th fingers at the dorsum of the wristin 1 patient (1.8%), dorsal pin migration with skin irri-tation in 3 patients (5.3%), volar pin migration (Fig. 4)in 1 patient (1.8%), and regional sympathetic dystro-

phy (RSD) in 8 patients (14.2%). All 3 patients treat-ed with additional external fixator were among the 8patients with RSD (Fig. 5). All the RSD patientsresponded to medical treatment except for one of theexternal fixator group, who had type-9 fracture andended up with limitation of motion of the wrist andfingers.

FIGURE 4. Good reduction and fixation of extra-articular fracture (a, b) with volar migration of one pin (c, d).

a b

dc


DISCUSSION

In 1976, Kapandji first reported a technique of intrafo-cal pinning for extra-articular dorsally displaced distalradius fractures, using two conventional Kirschnerwires [7]. He then made several technical modifica-tions, and sequentially recommended the use of fully

threaded pins, partially threaded pins with additionalend cup, and finally the special so-called “Arum” pins[11]. The aim was to improve the sustained buttressreduction effect of the pins, and to minimize pin relat-ed complications in terms of migration and soft tissueproblems. Although early indications were limited todorsal displaced extra-articular fractures, Kapandji

FIGURE 5. Intra-articular comminuted type-9 fracture treated with intrafocal pinning and External Fixator.Preoperative (a, b), postoperative (c, d) and final follow-up radiographs (e, f). Note the aspect of patchy osteoporotic changessecondary to regional sympathetic dystrophy.

a

b d f

c e


enlarged the spectrum of indications of his techniqueto include intra-articular fractures and volarly dis-placed fractures; more than two pins started to beemployed in order to stabilize different specific epi-physeal fragments [10,11].

For more than 20 years following the initial descrip-tion, Kapandji technique gained wide popularity in thetreatment of dorsally displaced distal radius fractures,especially in French literature.

Discordance between radiologic and clinical resultswas noted in our series. Our radiologic results weresatisfactory in 60.6% (30.3% excellent and 30.3%good) and unsatisfactory in 39.2% (25% fair and14.2% poor), while the clinical results were satisfacto-ry in 71.5% (37.5% excellent and 34% good) and un-satisfactory in 28.4% (14.2% fair and 14.2% poor).Kapandji reported 64% satisfactory, 21.15% fair, and15% poor clinical results, with improvement of theulnar variance in only 48% of cases [11]. He statedthat functional and anatomic results were not corre-lated, and noticed that many patients with malunionended up with good results and nearly normal wristfunction [11]. Epinette et al. reported 88% satisfactorysubjective and objective clinical results; nevertheless,the radiologic results of their series revealed 70% sat-isfactory (41% excellent and 29% good) and 30% un-satisfactory results (18% fair and 12% poor) with a29% incidence of malunion [14]. Haentjens and Casteleyncould not demonstrate any relationship between thequality of reduction and the final clinical result afterKapandji procedure [15]. In contrast, others consid-ered that clinical outcome depends on the fracture typeand treatment mo-dality, as well as the quality of re-duction [16].

Fornasieri et al. compared the results of intrafocalpinning of extra-articular “compression-extension”fractures with those of conservative treatment, usingcast immobilization [17]. Although functional resultswere uniformly excellent with both techniques at 21months follow-up, radiographic results were signifi-cantly better with the Kapandji procedure. Loss of ini-tial reduction at follow-up was noted by many authorsafter intrafocal pinning [9,14-16]. Excellent and goodradiographic results of our series dropped from 85.6%in the initial postoperative assessment to 60.6% atfinal follow-up, with a concomitant increase of fairand poor results from 14.2% to 39.2%. Althoughexcellent and good radiographic results were initiallyachieved in all type-2 fractures, only 73.3% remainedas such at the final follow-up, and 26.6% ended upwith fair and poor results; moreover 50% of type-2fractures that were initially qualified as having excel-lent initial reduction lost the reduction. Compared tothe initial radiographic results, fair and poor finalresults increased by 3 times for type-3, and doubledfor type-4 fractures; finally fair and poor results oftype-9 fractures increased from 50% in postoperative-ly to 70% at final follow-up (Table IV). According to

Kapandji, the occurrence of secondary displacementat the fracture site is usually related to borderline indi-cation of this procedure as well as to technical errors[9]. In 1987, he wrote a personal testimony after 10-year experience with his procedure, and acknowl-edged that the ideal indication for intrafocal pinningis the “simple” extra-articular Colles fracture withoutintra-articular extension or dorso-ulnar “third frag-ment”; only extra-articular fractures with minimaldorsal comminution and good bone quality may alsobenefit from intrafocal pinning [9].

Although Epinette et al. recommended using thistechnique in most cases of Colles’ fractures, they alsorecognized that “this method becomes gradually lesssatisfactory as the posterior comminution and thejoint involvement increase” [14]. Finally, Haentjensand Casteleyn observed “significant loss of reductionbetween the first postoperative day and the 1-year follow-up radiographs” [15].

Many authors compared the Kapandji procedure toother methods of pinning. A prospective comparativerandomized study by Fikry et al. demonstrated bet-ter overall objective and radiographic scores for thegroup of patients treated with Py procedure - anintramedullary flexible pinning - than those withKapandji procedure; however, subjective results werecomparable for both techniques [18]. The authors sug-gested that the Kapandji procedure is indicated forextra-articular Colles’ fractures without dorsal com-minution. For Delattre et al. [19,20], Kapandji tech-nique provided 85% of very good and good resultscompared to 70% for the Py technique; this differencewas even more evident in the incidence of poorresults, with 3.5% for Kapandji procedure and 18%for Py. Lenoble et al. were unable to demonstrate anyadvantages of intrafocal pinning over trans-styloidfixation at two years follow-up; however, althoughclinical results were comparable, radial shorteningand positive ulnar variance were significantly morecommon with the Kapandji procedure than thosetreated with trans-styloid fixation [16].

Fornasieri et al. noted ulno-carpal impingement in10.7% of patients treated with intrafocal pinning, acomplication directly related to radial shortening andpositive ulnar variance [17]. Jawish et al. have recent-ly suggested preventing this complication by an acuteshortening osteotomy of the distal ulna when perform-ing intrafocal pinning in osteoporotic wrist fractures[21]. In order to increase fixation stability, Delattreand Catonné recommended a modified Kapandji in-trafocal pinning, the combined or mixed-pinning; theyadvised multiplying the number of intrafocal pins asneeded in order to stabilize each specific and individ-ual fragment, and to replace the latero-radial intrafo-cal pin with a trans-styloid latero-radial pin, especiallyin comminuted metaphyso-epiphyseal fractures [22].

However, in general, all percutaneous methods ofpinning for distal radius fractures are better suitable


for extra-articular fractures without substantial meta-physeal comminution [3].

Over-reduction in the sagittal plane with iatrogenicincreased volar tilt was reported in association with anexaggerated “vertical” direction of the dorsal pins [9].Minimal increase of volar tilt without clinical impairmentoccurred in two patients of our series (3.5%) (Fig. 6).Peyroux et al. reported 5% of over-reduction with in-creased volar tilt; they recommended overcoming thisproblem by doing gentle reduction of the initial displace-ment and directing the dorsal pins not more than 45°along the axis of the radius [23].

Although a high overall complication rate was seen inour series (25%), only few of them can be qualified asbeing serious. Among the eight cases of RSD, five whohad been treated with intrafocal pinning alone, had com-plete resolution with medical treatment, without any se-quel; among the remaining three cases that had beentreated with additional external fixation, only one did notrespond to treatment and ended up with hand stiffness.

There were four cases of pin migration, and these can beconsidered as minor complications because they did notcause any injury to any of the nearby structures. Amongthe 14 complications in our series, we believe that onlytwo can be qualified as being serious and can be direct-ly related to the technique itself: the neuroma of the sen-sory branch of the radial nerve, and the rupture of theextensor of the 3rd and 4th fingers.

Various complications have been associated with theKapandji procedure in the literature, with a cumulativerate of 26% reported by Epinette et al. [14] and 60% byFornasieri et al. [17]. Epinette et al., however, stated thatcomplications associated with “negative” results wereonly seen in 7% of cases [14]. Pin migration was en-countered in 2.5-7% of cases [14,16,17,23], and was cor-related with the presence of osteoporosis [9,22]. Dorsalmigration necessitated premature removal because ofskin irritation and perforation, while volar migration re-quired a volar approach for removal [9]. Kapandji advo-cated overcoming the pin migration problem by usingpartially threaded pins and “Arum” type pins [11]. Teno-synovitis and rupture of extensor tendons at the dorsumof the wrist were encountered in about 7% [14,18]; accu-rate technique and use of pins with end cup or “Arum”type pins were advised to avoid tendon related problems[11]. Epinette et al. reported hypoesthesia of the sensorybranch of the radial nerve at the wrist without neuromain 4% [14], while Fornasieri et al. reported symptomaticneuromas in 21.5% of cases [17]. This complication canalso be avoided by a meticulous technique of pin inser-tion and pin removal. Although regional sympatheticdystrophic syndrome was reported with various inci-dences between 3 to 21% [14,17], it seems mainly relat-ed to the pain induced by early motion [16]; the practiceof immediate wrist and finger motion postoperativelywas promoted by Kapandji as a main advantage of thisprocedure [7, 9-11].

The relationship between functional outcome and ra-diographic findings after treatment of distal radius frac-tures has been debated [24,25]. The assumption that resti-tution of normal anatomy of the distal radius is associatedwith good functional results, especially in the elderly [27],has triggered many discussions [26]. Although many clas-sical reports showed direct relationship between goodresults and restitution of the anatomy of distal radius frac-tures in young adults [28-30], only few articles utilizedevaluation tools based on patient-perceived outcome [31-35]. Recent literature reveals a rising interest for openreduction and internal fixation of distal radius fractureswith volar locking plates [31,34-36]. A prospective ran-domized study by McFadyen et al. showed better clinicaland radiologic results with volar locking plates, comparedwith percutaneous pinning, even for extra-articular frac-tures [37]. Nevertheless, both, a recent Cochrane Review[5] and a guideline report on distal radius fractures [6],were unable to suggest enough evidence-based clinicalpractice guidelines to recommend one method of surgicalfixation over another.

FIGURE 6. Increased volar tilt of the distal radiusat final follow-up without clinical manifestation.


CONCLUSION

Our clinical and radiological results were overall satis-factory and comparable to the literature; however,because of the propensity for gradual and progressiveloss of reduction encountered after intrafocal pinning,the decision to use it should be carefully considered,especially in articular fractures and metaphyseal com-minution.

REFERENCES

1. Davis DI, Baratz M. Soft tissue complications of distalradius fractures. Hand Clin 2010; 26: 229-35.

2. Ipaktchi K, Livermore M, Lyons C, Banegas R. Currentconcepts in the treatment of distal radial fractures.Orthopedics 2013; 36: 778-84.

3. Schneppendahl J, Windolf J, Kaufmann RA. Distal ra-dius fractures: Current concepts. J Hand Surg 2012; 37A:1718-25.

4. Knirk JL, Jupiter JB. Intra-articular fractures of the distalend of the radius in young adults. J Bone Joint Surg (Am)1986; 68-A: 647-59.

5. Handoll HH, Huntley JS, Madhok R. Different meth-ods of external fixation for treating distal radial frac-tures in adults. Cochrane Database Syst Rev 2008:CD006522

6. The treatment of distal radius fractures: guideline and evi-dence report. Adopted by the American Academy of Or-thopaedic Surgeons Board of Directors. 2009. Availableat: http://www.aaos.org/research/guidelines/drfguideline. pdf.Accessed January, 2012.

7. Kapandji AI. Ostéosynthèse par double embrochageintrafocal. Traitement fonctionnel des fractures non arti-culaires de l'extrémité inférieure du radius. Ann Chir1976; 30: 903-8

8. Shauver MJ, Clapham PJ, Chung KC. An economic anal-ysis of outcomes and complications of treating distalradius fractures in the elderly. J Hand Surg 2011; 36A:1912-18.

9. Kapandji A. L'embrochage intra-focal des fractures del'extrémité inférieure du radius dix ans après. Ann ChirMain 1987; 6: 57-63

10. Hoël G, Kapandji AI. Ostéosynthèse par broches intra-focales des fractures à déplacement antérieur de l’épi-physe radiale inférieure. Ann Chir Main 1995; 14: 142-57.

11. Kapandji AI. Ostéosynthèse par brochage intrafocal detype “Arum” des fractures récentes du radius distal chezl’adulte. In: Fractures du radius distal de l’adulte. Cahiersd’enseignement de la SOFCOT. Nº 67. Sous la directionde Allieu Y. Paris: Expansion Scientifique Publications,1998: pp 67-83.

12. Chammas M, Meyer zu Reckendorf G, Allieu Y. Méca-nismes et classifications des fractures du radius distal del’adulte. In: Fractures du radius distal de l’adulte. Cahiersd’enseignement de la SOFCOT, Nº 67. Sous la directionde Allieu Y. Paris: Expansion Scientifique Publications,1998: pp 28-47.

13. Gartland JJ, Werley CW. Evaluation of healed Colles'fractures. J Bone Joint Surg (Am) 1951; 33-A: 895-907.

14. Epinette JA, Lehut JM, Cavenaile M, Bouretz JC, Decoulx J.Fracture de Pouteau-Colles: Double embrochage intra-focal en berceau selon Kapandji. A propos d’une sériehomogène de soixante-douze cas. Ann Chir Main 1982;1: 71-83.

15. Haentjens P, Casteleyn PP. The Kapandji pinning tech-nique for the treatment of fractures of the distal radius.Operat Orthop Traumatol 1996; 8: 20-30.

16. Lenoble E, Dumontier C, Goutallier D, Apoil A. Fractureof the distal radius. A prospective comparison betweentrans-styloid and Kapandji fixations. J Bone Joint Surg(Br) 1995; 77-B: 562-7.

17. Fornasieri C, Chaussard C, Develay O et al. Étude com-parative embrochage selon Kapandji versus traitementorthopédique des fractures du radius de type Pouteau-Colles. In: Fractures du radius distal de l’adulte. Cahiersd’enseignement de la SOFCOT, Nº 67. Sous la directionde Allieu Y. Paris: Expansion Scientifique Publications,1998: pp 84-91.

18. Fikry T, Fadili M, Harfaoui A, Dkhissi M, Zryouil B.Fractures métaphysaires du radius distal: embrochage deKapandji ou de Py ? Ann Chir Main 1998; 17: 31-40.

19. Delattre O, Saillant G, Lemoine J, Benazet JP, Roy-Camille R. Réduction et synthèse par brochage des frac-tures du poignet. Étude comparative entre la technique deKapandji et la technique de Py. Rev Chir Orthop 1994;80: 94-107.

20. Delattre O, Besson A, Uzel M, Mousselard H, RouvillainJL, Catonné Y. Brochage intrafocal modifié dans les frac-tures de l’extrémité inférieure du radius. Rev Chir Orthop1996; 82 (Suppl II): 14-15.

21. Jawish R, Najdi H, Chamseddine A. Shortening of thedistal ulna to correct ulnar variance in osteoporotic wristfractures treated with intra-focal pining. Eur J OrthopSurg Traumatol 2015; 25: 1019-23.

22. Delattre O, Catonné Y. Étude critique et comparative destechniques de Py et de Kapandji, implications thérapeu-tiques: le brochage intrafocal modifié. In: Fractures duradius distal de l’adulte. Cahiers d’enseignement de laSOFCOT, Nº 67. Sous la direction de Allieu Y. Paris:Expansion Scientifique Publications, 1998: pp 111-26.

23. Peyroux LM, Dunaud JL, Caron M, Ben Slamia I,Kharrat M. La technique de Kapandji et son évolutiondans le traitement des fractures de l’extrémité inférieuredu radius. À propos d’une série de 159 cas. Ann ChirMain 1987; 6: 109-22.

24. Palmer AK. Fractures of the distal radius. In: Operativehand surgery. Green DP, ed. New York: ChurchillLivingstone, 1988; pp 991-1026.

25. Peltier LF. Fractures of the distal end of the radius: anhistorical account. Clin Orthop Rel Res 1984; 187: 18-22.

26. Fernandex DL. Should anatomic reduction be pursued indistal radial fractures? J Hand Surg (Br) 2000; 25: 523-7.

27. Jaremko JL, Lambert RG, Rowe BH, Johnson JA,Majumdar SR. Do radiographic indices of distal radius


fracture reduction predict outcomes in older adults re-ceiving conservative treatment? Clin Radiol 2007; 62:65-72.

28. Knirk JL, Jupiter JB. Intra-articular fractures of the distalend of the radius in young adults. J Bone Joint Surg (Am)1986; 68-A: 647-59.

29. McQueen M, Caspers J. Colles fracture: does the ana-tomical result affect the final function? J Bone Joint Surg(Br) 1988; 70-B: 649-51.

30. Trumble TE, Schmitt SR, Vedder NB. Factors affect-ing functional outcome of displaced intra-articulardistal radius fractures. J Hand Surg (Am) 1994; 19:325-40.

31. Wright TW, Horodyski M, Smith DW. Functional out-come of unstable distal radius fractures: ORIF with avolar fixed angle tine plate versus external fixation. JHand Surg (Am) 2005; 30: 289-99.

32. Rozental TD, Blazar PE. Functional outcome and com-plications after volar plating for dorsally displaced, un-stable fractures of the distal radius. J Hand Surg (Am)2006; 31: 359-65.

33. Wilcke MK, Abbaszadegan H, Adolphson PY. Patient-perceived outcome after displaced distal radius fractures:a comparison between radiological parameters, objectivephysical variables, and the DASH score. J Hand Ther2007; 20: 290-8.

34. Hakimi M, Jungbluth P, Windolf J, Wild M. Functionalresults and complications following locking palmar plat-ing on the distal radius: a retrospective study. J HandSurg (Eur) 2010; 35: 283-8.

35. Sügün TS, Gürbüz Y, Özaksar K, Toros T, Kayalar M,Bal E. Results of volar locking plating for unstable distalradius fractures. Acta Orthop Traumatol Turc 2012; 46:22-5.

36. Downing ND, Karantana A. A revolution in the manage-ment of fractures of the distal radius? J Bone Joint Surg(Br) 2008; 90-B: 1271-5.

37. McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C.Should unstable extra-articular distal radial fractures betreated with fixed angle volar-locked plates or percuta-neous Kirschner wires? A prospective randomised con-trolled trial. Injury 2010; 42: 162-6.

ORTHOPAEDICS INTRAFOCAL PINNING FOR DORSALLY … · Kapandji in 1976 [7], has gained large...

Documents

Transcript of ORTHOPAEDICS INTRAFOCAL PINNING FOR DORSALLY … · Kapandji in 1976 [7], has gained large...