Definition & Overview

Percutaneous skeletal fixation is the surgical procedure of treating fractures by inserting surgical implants through the skin. It is applicable in the treatment of fractures in the pelvis and other bones in the body, including the spine. It is also known as percutaneous pinning.

A fracture refers to a break in a bone commonly resulting from accidents, falls, or contact injury during sports. In some cases, the presence of osteoporosis and low bone density makes a person at high risk of developing fractures, which cause intense pain, swelling, and tenderness in the injured part.

There are generally two types of orthopaedic procedures to fix implants for bone repair and these are open and closed reduction internal fixation techniques. The former involves open surgery while the latter is the minimally invasive alternative to the procedure.

Who Should Undergo and Expected Results

Those with fractures in different parts of their bodies are offered percutaneous skeletal fixation. These include:

• Fracture of the humerus or the long bone in the arm, which is quite common among children below ten years old
• Fractured fingers
• Fractured pelvic ring, which typically results from vehicle accidents, falling from great heights or being crushed by a heavy object
• Sacral fractures
• Fractured vertebrae

This procedure is considered a safe and effective method of treating fractures in several parts of the body. In most paediatric patients, the fractures heal completely with no adverse impact on bone growth later on. This procedure also avoids complications associated with open fixation technique, which includes bleeding and disruption of nearby body parts.

When necessary, the affected body part is placed on a sling to minimise movements and patients are required not to engage in strenuous activities for several weeks. Most are also required to undergo physical rehabilitation to encourage healing and resume functionality.

How is the Procedure Performed?

The techniques used for percutaneous skeletal fixation are varied, depending on the location and type of fracture. Regardless of the technique used, the procedure is typically performed under local anaesthesia and with the use of imaging technology, which allows visualisation of the bones and assists in guiding the implants to the desired location. Some procedures are done with fluoroscopy while others are performed with the help of computed tomography (CT scan). For fractures near joints, the surgeon will also restore alignment using specialised orthopaedic tools to ensure that the fracture will heal properly.

For the procedure, the surgeon makes a small stab incision where the implants are inserted to keep the bones in place and fix the fractured parts. Depending on the need, threaded pins and cannulated screws are placed. Specialised tools are then used to manipulate the pins into position to provide optimal support to the fractured bone. The placement of implants is then assessed using imaging technology before the tools are withdrawn.

Possible Risks and Complications

Percutaneous skeletal fixation reduces the risk of excessive bleeding and infection that are typically associated with open surgery. However, there is the possibility of injuring nearby or adjacent body parts such as blood vessels and nerves, which could lead to compromised functioning of the affected part and in severe cases, partial paralysis.

Though rare, there are still reports of pin site infection, which is typically resolved with antibiotic medication. Some patients also report stiffness in the affected part of the body, especially if it involves the joints.

Reference:

• Fernandez, Diego L.; Jesse B. Jupiter (2002). Fractures of the Distal Radius: A Practical Approach to Management (Second ed.).