CHAPTER 18 Use of the T-Pin in the Treatment of Extra-articular Distal Radius Fractures
Distal radius fractures are among the most common fractures treated by orthopaedic surgeons. Numerous techniques and implants have been devised to stabilize these fractures. The T-Pin (Union Surgical, LLC, Philadelphia, PA) is a novel instrument designed to stabilize extra-articular distal radius fractures utilizing minimal surgical dissection. The T-Pin allows for early active wrist range of motion, thus promoting earlier return to functional activities. Here we discuss the instrumentation, the techniques of insertion and extraction, and the postoperative care required for the use of the T-Pin in the treatment of extra-articular distal radius fractures.
Historical Perspective
Fractures of the distal radius are one of the most common fractures treated by orthopaedic surgeons. Owen stated that distal radius fractures represent one in six fractures in patients older than 50 years of age.1 Various procedures and fixation techniques have evolved to treat this common fracture based on many factors, which include the patient’s age, bone quality, and ability to tolerate the procedure and the type of fracture. Treatment modalities have included immobilization as originally described by Colles,2 pins in plaster, external fixation, percutaneous pinning with casting, and open reduction with internal fixation with a number of different implants.
Since Abraham Colles described the comminuted and displaced distal radius fracture in 1814, orthopaedic surgeons have sought to stabilize the fracture after reduction.3 Many fractures treated in plaster have a tendency to redisplace.4 For this reason, percutaneous pinning evolved as a relatively simple fixation method for extra-articular fractures prone to redisplacement with cast treatment alone. Various methods of pinning have been developed. The described techniques include two pins placed through the radial styloid5; two crossed pins, one inserted at the radial styloid just dorsal to the first extensor compartment and the second inserted on the dorsal ulnar aspect of the distal radius between the fourth and fifth extensor compartments3,6; three to four intrafocal pins within the fracture site7; transulnar oblique pinning in which a threaded wire is inserted in the distal ulna and passed obliquely through the distal ulna to the distal radius so that it engages the radial styloid fragment8; one radial styloid pin and a second across the distal radioulnar joint9; and multiple transulnar to radius pins, including the distal radioulnar joint.10 Despite improved maintenance of reduction with pinning, many of these series report 25% to 33% of patients having a significant loss of reduction.
The T-Pin is a threaded pin designed specifically to treat acute distal radius fractures. The T-Pin technique has the advantages of (1) a short operative time, (2) being relatively inexpensive, (3) having utility for patients with medical conditions for whom general anesthesia poses a greater risk, and (4) allowing early active wrist motion. The T-Pin is threaded and affords better purchase of the fracture fragments than commonly used smooth pins (Fig. 18-1). Currently, we are undergoing a prospective multicenter study to further evaluate the efficacy of the procedure.
Indications and Contraindications
The main indication for use of the T-Pin is an unstable extra-articular dorsally displaced distal radius fracture (Fig. 18-2). This technique is useful for active patients because it is a relatively brief procedure and allows for a quick return of function. The brief nature of the procedure, especially the limited incisions (1 to 2 cm) required to insert the pins, makes this procedure useful in the elderly and medically unstable populations because it can be performed under local anesthesia with intravenous sedation.
