A Prospective, Randomized Study of Displaced Pediatric Metaphyseal Distal Radius Fractures: Cast Immobilization versus Percutaneous Pin Fixation

Bruce Miller, MD
Advisor: Peter Waters, MD
Discussor: Keith Mankin, MD

Dr. Bruce Miller presented his work performed under the guidance of Dr. Peter Waters. Thirty-four skeletally immature patients with unstable displaced fractures of the distal radius were randomized to treatment either with closed reduction and casting or percutaneous pin fixation. With average follow-up of three years, all fractures healed and no difference was found in functional outcome. Though there were no major complications, loss of reduction requiring re-manipulation did occur in the casting group and there was a significant inci-dence of superficial pin tract infection in the pinning group. There were no differences in cost between the two treatment groups as performed in this study.

Dr. Keith Mankin led the discussion of Dr. Miller’s presentation, emphasizing the importance for prospective, randomized control studies in clinical orthopaedic research and commending Dr. Miller for his study design. Citing the changing pressures of the current health care climate, Dr. Mankin raised the issue of whether percutaneous pinning may prove to be a more cost-effective mode of treatment, given the need for fewer follow-up office visits and radiographs. He encouraged further study of this aspect of fracture care in children.

In Vivo Evaluation of Coralline Hydroxyapatite and Direct Current Electrical Stimulation in Lumbar Spinal Fusion

Kevin Bozic, MD
Advisor: Stephen Lipson, MD, Paul Glazer, MD
Discussor: Richard Ozuna, MD

Noting the increasing number of active persons over the age of 60 years in the United States, Dr. Paul Weitzel presented his thesis. In this project, he and his advisor, Dr. Jesse Jupiter, studied 25 patients over the age of 60 years who failed closed reduction and cast immobilization of their distal radius fractures and went on to open reduction and internal fixation. After an average follow-up of three years, all patients went on to heal their fractures, with 95% excel-lent or good radiographic results. Using the Patient Rated Wrist Evaluation and Physical Activity Survey of Elderly scores, these patients were found to have clinical and functional results comparable to patients of all ages with similar injuries. Only 10% had any decrease in their pre-injury activity, and there were no cases of implant failure or loss of fixation, despite concerns of osteoporotic bone. Dr. Weitzel concluded that age should not influence the decision to sur-gically fix distal radius fractures, and that good functional results can be achieved in patients older than 60 years. 

Dr. Richard Ozuna led the discussion of this paper, noting that the hematologic analysis of the bone marrow aspirates performed on these animals revealed no more osteoprogenitor cells than peripheral venous blood. He raised the question of whether DC electrical stimulation may be an osteoin-ductive agent in this non-primate animal model of spinal fusion.