Percutaneous pinning is a minimally invasive surgical technique used by orthopedic and podiatric surgeons to stabilize bone fractures. It involves inserting thin metal pins directly through the skin into fractured bone segments. Its purpose is to hold the bone fragments in proper alignment, allowing them to heal.
Understanding Percutaneous Pinning
This method uses small skin punctures to introduce thin metal pins into bone fragments. Surgeons use real-time X-ray imaging, known as fluoroscopy, to guide the precise placement of these pins without directly viewing the fracture site. The pins function as internal splints, providing stability to the fractured bone during healing.
When This Procedure is Used
Orthopedic surgeons frequently choose percutaneous pinning for specific types of fractures that require stabilization but can be realigned without large surgical exposure. This often includes stable fractures or those displaced but not significantly misaligned, particularly in smaller bones like the hand, wrist, foot, and elbow. It is also commonly applied for certain growth plate fractures in children. The technique minimizes soft tissue damage, reduces infection risk compared to open surgery, and can lead to quicker recovery.
How the Procedure is Performed
The percutaneous pinning procedure typically begins with the patient receiving anesthesia, which can be local, regional, or general, to ensure comfort. In a sterile operating room, the surgeon first repositions the fractured bone fragments into their correct anatomical alignment, a process called closed reduction. Real-time fluoroscopy then guides the precise insertion of the thin metal pins through small skin punctures. These pins are driven into one bone fragment and across the fracture line into the opposing fragment, securing alignment. The pins are generally left protruding slightly from the skin for eventual removal once healing is sufficient.
Life with Pins and Recovery
After percutaneous pinning, patients typically experience some discomfort and swelling. The injured area is often immobilized with a cast or splint to protect the pins and support the healing bone. Maintaining cleanliness at the pin sites is important to prevent infection, often involving daily cleaning. Pins usually remain in place for four to six weeks, or until X-rays confirm adequate bone healing. Pin removal is a simple procedure performed in a doctor’s office, after which physical therapy may be recommended to restore range of motion and strength.
Important Considerations
Patients with percutaneous pins should be aware of potential issues such as pin site infection, characterized by increased pain, redness, warmth, swelling, or drainage around the pin. While superficial infections are relatively uncommon, occurring in about 1% of cases, prompt attention is important. Other less frequent concerns include pin loosening or migration, and rarely, nerve or blood vessel injury. Any signs of severe pain, worsening swelling, fever, or changes in sensation or circulation in the affected limb warrant immediate medical evaluation.