Abstract
OBJECTIVE: To compare the effectiveness of two single-pin internal fixation techniques-trans-fracture in-out-in Kirschner wire fixation and antegrade elastic stable intramedullary nailing (ESIN) from the radial mid-shaft-in the treatment of distal radial metaphyseal diaphyseal junction (DRMDJ) fractures. METHODS: A retrospective analysis was conducted on 48 pediatric and adolescent male patients with DRMDJ fractures who met the selection criteria and were treated between January 2022 and December 2024. Among them, 27 patients underwent trans-fracture in-out-in Kirschner wire fixation (group A), and 21 patients underwent antegrade ESIN from the radial mid-shaft (group B). There was no significant difference in baseline data between the two groups ( P>0.05), including age, cause of injury, affected side, presence of associated ulnar fracture, time from injury to surgery, or fracture classification. The operation time, intraoperative fluoroscopy frequency, fracture reduction rates on anteroposterior and lateral views, fracture healing time, and postoperative complications were recorded and compared. Clinical efficacy were evaluated at last follow-up using the Gartland-Werley scoring system. RESULTS: All surgeries were successfully completed. The operation time was shorter in group A than in group B, with a significant difference ( P<0.05). No significant difference was found in the intraoperative fluoroscopy frequency between the two groups ( P>0.05). All patients were followed up, with a follow-up time of (11.81±2.09) months in group A and (12.10±2.74) months in group B, showing no significant difference ( t=-0.389， P=0.699). In group A, 3 patients experienced Kirschner wire irritation to the skin, which resolved after wound care, adjustment of cast fixation, or early pin removal. No complications such as tendon rupture, osteomyelitis, or nonunion occurred in either group. X-ray films taken on the second postoperative day showed that the fracture reduction rates on both anteroposterior and lateral views reached approximately 90% in each group, with no significant difference between groups ( P>0.05). All fractures achieved bony union, and there was no significant difference in healing time between groups ( P>0.05). At last follow-up, according to the Gartland-Werley score, 24 cases were rated as excellent and 3 as good in group A, while 19 cases were excellent and 2 good in group B, yielding an excellent-good rate of 100% in both groups. CONCLUSION: Both fixation techniques achieved satisfactory effectiveness. However, the trans-fracture in-out-in Kirschner wire fixation technique is simpler to perform, requires shorter operation time and eliminates the need for implant removal, making it a potentially preferable option for treating this type of fracture.