External fixation and percutaneous pinning for distal radius fractures

Distal radius fractures are the second most common fracture seen in the Emergency Department. Many patients may be treated nonoperatively, with closed reduction and immobilization. For those patients in whom satisfactory reduction cannot be achieved, a number of surgical options exist. External fixation is a valuable and effective option in certain patients. Specific indications include: intra- and extra-articular dorsally angulated fractures that fail closed reduction, severely comminuted fractures, open fractures, and fracture-dislocations of the wrist. Favorable outcomes have been reported. Specifically, percutaneous pinning in addition to external fixation yields better outcomes than fixation alone. Several studies comparing external fixation and volar plating have shown no significant differences in pain, grip strength, or range of motion. Technical pearls and pitfalls are described here, as proper technique and consideration of the principles of external fixation are necessary.