Surgical Pinning (CRPP) for a Wrist (Distal Radius) Fracture

What this surgery is

The distal radius is the larger forearm bone where it meets the wrist — a very common place for children to break a bone. Your child had a closed reduction and percutaneous pinning (CRPP): the surgeon lined the bones back up without a large incision and placed one or two smooth metal pins (K-wires) through the skin and across the break to hold the wrist in a good position while it heals.

The wrist is then protected in a cast (short-arm or long-arm). The pin ends are left just outside the skin, under the cast, so they can be removed easily in the office.

Why it was done

This fracture was either unstable or too out of place to hold its position in a cast alone. Pinning keeps the bone lined up so the wrist heals straight and the growth plate is protected.

The cast

• Keep the cast clean and completely dry.
• Keep the hand and wrist raised above the heart as much as possible for the first 2–3 days.
• Wiggling the fingers often helps reduce swelling and stiffness.
• Nothing inside the cast; no powder or lotion at the edges.

Pin care

• The pins stay covered under the cast — no cleaning is needed at home.
• A little clear or pink drainage at the pin sites can be normal.
• Pins are removed in the office, usually about 3–4 weeks after surgery, and most children do not need anesthesia for this.

Pain control

• Acetaminophen (Tylenol) and ibuprofen (Motrin), used as directed, control most discomfort.
• Elevation in the first days is one of the best ways to ease pain.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 100.4°F (38°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Foul smell or pus-like drainage from the cast or pin sites
• The cast becomes wet, cracked, soft, too loose, or too tight
• Something gets stuck inside the cast

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Expect an office X-ray at about 1 week and pin/cast removal at about 3–4 weeks. Most wrist fractures heal in about 4–6 weeks. A short period of stiffness is normal and resolves with normal use.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Percutaneous pinning). It is provided by pediatric orthopaedic surgeons.