Observational studyJournal of orthopaedic surgery and research2026
Intramedullary versus crossed pinning for paediatric distal radius fractures: clinical decision patterns and biomechanical validation integrating real-world practice with growth plate stress finite element analysis.
Observational study in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis observational study characterized clinical outcomes and decision patterns for intramedullary (IM) versus crossed pinning (CP) in paediatric distal radius fractures, integrating real-world practice with growth plate-inclusive finite element analysis (FEA) to elucidate biomechanical profiles, particularly physeal safety.
methodsRetrospective analysis of 102 children (43 IM, 59 CP) undergoing closed reduction and percutaneous fixation (2018-2023). Baseline differences included younger age (IM 8.3 ± 2.7 vs. CP 12.3 ± 3.3 years, p < 0.001) and more proximal fractures (IM 25.0 ± 6.1 vs. CP 15.9 ± 2.7 mm from physis, p < 0.001). Outcomes included Gartland-Werley score, complications, and radiographic parameters. FEA simulated axial (100 N) and torsional (1 N·m) loads at 15 mm and extended 25 mm fracture locations, with sensitivity analysis on growth plate modulus.
resultsFunctional outcomes were excellent and equivalent (Gartland-Werley: IM 0.26 ± 0.54 vs. CP 0.49 ± 0.78, p = 0.22). No growth arrest occurred. A nonsignificant infection trend favored IM (1/43 vs. 5/59, p = 0.22). Both groups achieved equivalent immediate postoperative alignment. FEA showed comparable axial stability at both locations. Under torsion, CP demonstrated superior stability (15 mm: 25-26% less displacement/physeal stress; amplified to 41-42% less at 25 mm), with trends robust to modulus variation.
conclusionBoth techniques yielded excellent outcomes when applied per observed patterns (IM for younger/proximal; CP for older/distal fractures). Position-dependent FEA insights, showing enhanced CP torsional advantages proximally, support an observed clinical practice pattern suggesting an approximate 20-25 mm threshold that warrants prospective validation. Limitations include retrospective design, unmodeled cast effects, and FEA simplifications.
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