FUNCTIONAL OUTCOME OF CLOSE REDUCTION AND PERCUTANEOUS PINNING IN COLLES FRACTURE UNDER IMAGE INTENSIFIER

Abstract

Background Colles’ fractures are common distal radius fractures that may result in pain, restricted wrist motion, reduced grip strength and impaired hand function when satisfactory alignment is not achieved or maintained. Closed reduction and percutaneous pinning (CRPP) under image-intensifier guidance provides a minimally invasive method of maintaining reduction in appropriately selected unstable fractures. However, functional recovery remains an important endpoint because radiographic restoration does not always translate directly into functional recovery. Local evidence regarding functional outcomes following CRPP for Colles’ fracture remains limited. Objective To determine the frequency of excellent, good and fair functional outcomes at six months postoperatively among patients with Colles’ fracture treated with closed reduction and percutaneous pinning under image-intensifier guidance, using the Modified Cooney Wrist Score. Methods A descriptive longitudinal study was conducted in the Department of Orthopaedics, Ayub Teaching Hospital, Abbottabad, Khyber Pakhtunkhwa, Pakistan, from 5 December 2025 to 5 June 2026. A total of 149 adult patients aged 20–70 years with unilateral Frykman type I or II Colles’ fractures presenting within seven days of injury and undergoing CRPP under image-intensifier guidance were included through non-probability consecutive sampling. Closed reduction was performed with longitudinal traction followed by palmar flexion and ulnar deviation, and fixation was achieved using two or three 1.8-mm Kirschner wires according to fracture stability. Functional outcome was assessed at six months using the Modified Cooney Wrist Score, which evaluates pain, functional status, range of motion and grip strength, with a total score of 100. Outcomes were categorized as excellent (90–100), good (80–89) or fair (65–79). Data were analyzed using IBM SPSS Statistics version 26. Associations between functional outcome and demographic or fracture-related variables were assessed using the chi-square test or Fisher’s exact test, as appropriate, with p≤0.05 considered statistically significant. Results The mean age of the study participants was 52.0±11.0 years, with a median age of 53 years (IQR 44–60). Female patients comprised 86 (57.7%) of the study population, while 63 (42.3%) were male. Right-sided fractures were present in 79 (53.0%) patients and left-sided fractures in 70 (47.0%). Frykman type I fractures accounted for 85 (57.0%) cases and type II fractures for 64 (43.0%). At six months, 78 (52.3%) patients achieved an excellent functional outcome, 60 (40.3%) had a good outcome and 11 (7.4%) had a fair outcome. The mean Modified Cooney Wrist Score was 88.9±9.0, with median of 90 (IQR 84–95). The mean scores for pain, functional status, range of motion and grip strength were 22.5±3.4, 22.0±3.5, 22.1±3.2 and 22.3±3.4, respectively. No statistically significant association was observed between functional outcome and age, gender, BMI, side of involvement, Frykman classification, socioeconomic status, educational level or residential status (p>0.05 for all comparisons). Conclusion In this selected cohort of adults with unilateral Frykman type I and II Colles’ fractures, closed reduction and percutaneous pinning under image-intensifier guidance was associated with predominantly favorable functional outcomes at six months. More than half of the patients achieved an excellent Modified Cooney Wrist Score and a further substantial proportion achieved a good outcome. The findings support CRPP as a practical treatment option for appropriately selected Colles’ fractures in which satisfactory closed reduction can be achieved and maintained. Comparative studies involving other fixation methods and longer follow-up are needed to further evaluate functional recovery.