Percutaneous K-wires vs palmar locking plate fixation for different types of distal radial fractures: a comparison of the outcomes of two methods to controll our guidelines

2018 ◽  
Vol 50 (05) ◽  
pp. 319-325
Author(s):  
Andrzej Zyluk ◽  
Piotr Janowski ◽  
Zbigniew Szlosser ◽  
Piotr Puchalski
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Fixation Method ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Fixation Group ◽  
Palmar Plate ◽  
Wire Fixation ◽  
K Wires ◽  
Dorsal Flexion

AbstractThe objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation. Patients and Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures. Results: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group. Conclusion: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.

scholarly journals 653 DRAFFT Dodging? Fixation Methods for Distal Radial Fractures Since 2014 In A UK Trauma Unit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Gilbert ◽  
H Akehurst ◽  
J Mutimer
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Distal Radius Fractures ◽  
Fixation Method ◽  
Radius Fractures ◽  
Locking Plate Fixation ◽  
Fixation Methods ◽  
K Wires

Abstract Introduction The 2014 randomised, controlled Distal Radius Acute Fracture Fixation Trial (DRAFFT) compared K-wires to internal fixation for management of dorsally displaced distal radius fractures. The authors found no clinical difference between the two fixation methods, concluding ‘The results of this trial will reverse the trend towards locking-plate fixation for this injury’. Our study aimed to measure local change in practice since 2014. Method From the DRAFFT CONSORT diagram, we calculated just 10.7% of eligible cases required locking plate fixation. 300 patients, 50 per year from 2014-19 meeting DRAFFT eligibility criteria undergoing fixation, were randomly selected from an electronic trauma database. Radiographs were reviewed to see whether patients received internal fixation or K-wires. Results Age and sex distributions of the study sample were not significantly different to the DRAFFT population (p < 0.05). Over 60% of recruited patients received internal fixation each year. No increasing trend in use of K-wires was detected (p = 0.27). No trend was observed in either fixation method adjusting for intra versus extra-articular fractures (p = 0.36). Conclusions Local practice remains unchanged in fixation of dorsally displaced distal radius fractures since 2014. Internal fixation remains the most prevalent surgery, and there has been no detectable increase in use of K-wires.

Complications following volar locking plate fixation for distal radial fractures: a systematic review

2013 ◽  
Vol 39 (7) ◽  
pp. 745-754 ◽  
Author(s):  
A. Bentohami ◽  
K. de Burlet ◽  
N. de Korte ◽  
M. P. J. van den Bekerom ◽  
J. C. Goslings ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Locking Plate ◽  
Assessment Tool ◽  
Plate Fixation ◽  
Assessment Tools ◽  
Volar Locking Plate ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Level Of Evidence

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were ‘minor’ complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly

2019 ◽  
Vol 101 (11) ◽  
pp. 961-969 ◽  
Author(s):  
Jenny Saving ◽  
Sara Severin Wahlgren ◽  
Kristin Olsson ◽  
Anders Enocson ◽  
Sari Ponzer ◽  
...  
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
The Elderly ◽  
Nonoperative Treatment ◽  
Volar Locking Plate ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures

Incidence of tendon ruptures after locking plate fixation of distal radial fractures: are the cited rates still accurate?

2020 ◽  
pp. 175319342094846
Author(s):  
Daniel J. Brown ◽  
Neal Ormsby ◽  
Olivia C. Brown ◽  
Graham Cheung
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Large Change ◽  
Contributing Factors ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Plate Design ◽  
Tendon Ruptures

With the introduction of the anterior locking plate in the early part of this century, there was a large change in how distal radial fractures were treated. Early articles about the techniques reported tendon ruptures occurring in as many as 10%, although studies from our unit reported rates closer to 2%. Subsequent refinements in surgical technique and improvements in plate design have been made with the aim of reducing the number of ruptures. Despite this, the original articles and their rates continue to be quoted. In this retrospective study of 798 cases treated with anterior locking plates, tendon ruptures have been significantly reduced and are now as low as 0.5%. Contributing factors leading to this improvement are identified and discussed. Level of evidence: III

scholarly journals UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

2015 ◽  
Vol 19 (17) ◽  
pp. 1-124 ◽  
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Caroline Plant ◽  
Nick R Parsons ◽  
Amar Rangan ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Health Technology ◽  
Kirschner Wires ◽  
Locking Plate Fixation ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Displaced Fracture

BackgroundIn high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation.MethodsIn this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation©(PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness.ResultsThe baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: –1.3; 95% confidence interval (CI) –4.5 to 1.8;p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI –0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (–£727; 95% CI –£588 to –£865), particularly in younger patients.ConclusionsContrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform.Trial registrationCurrent Controlled Trials ISRCTN31379280.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.

scholarly journals Screw Length in Volar Locking Plate Fixation for Distal Radial Fractures

2015 ◽  
Vol 23 (2) ◽  
pp. 164-167 ◽  
Author(s):  
Grace Yuen ◽  
Dennis KH Yee ◽  
Christian Fang ◽  
Tak-Wing Lau ◽  
Frankie Leung
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Volar Locking Plate ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Screw Length
Sign in / Sign up

Export Citation Format

Share Document