Is external fixation a better way than plaster to supplement K-wires in non-comminuted distal radius fractures?

2017 ◽  
Vol 94 (1107) ◽  
pp. 20-24 ◽  
Author(s):  
Sajjad M Athar ◽  
Neil Ashwood ◽  
George Aerealis ◽  
Gregory I Bain
Keyword(s):  
Range Of Motion ◽  
External Fixation ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Wire Fixation ◽  
K Wires ◽  
Metaphyseal Comminution

BackgroundDistal radius fractures represent about one-sixth of all fractures. There is still no consensus on the treatment of this fracture. We have several issues to assess and address; one of them is the fixation method. We tried to compare the effectiveness of two methods of stabilisation of distal radial fracture. Comparison between the techniques of Kirschner wire (K-wire) fixation with plaster and K-wire fixation with external fixation (Ex-Fix) was undertaken to assess which treatment modality gives better results in patients with distal radius fracture Frykman VII and VIII with no metaphyseal comminution.MethodFifty-six patients were chosen randomly and then allocated to two different modalities of stabilisation randomly as well, they were followed up; three of them were lost to follow-up because of death and two moved away from the area. Fifty-one patients were randomised in two groups: 24 were treated with K-wire and spanning Ex-Fix supplementation and 27 were treated with K-wires and plaster. Patients were prospectively monitored following the operation with a minimum follow-up of 1 year. Measurement of range of motion was obtained after surgery. Visual Analogue Scale (VAS) scores for pain and satisfaction levels were also recorded.ResultsThere was statistically significant difference in favour of the Ex-Fix patient group for pain (VAS, Ex-Fix group: mean 14.9; plaster group: mean 28.1) and satisfaction (Ex-Fix group: mean 89.7;plaster group: mean 76.3). Although one would expect that range of motion would be reduced in the Ex-Fix group, there were no statistically significant differences found, with the exception of supination where results were in favour of the Ex-Fix group (mean 54.4; plaster group: mean 45.2).ConclusionIn our study, xternal fixator (Ex-Fix) supplementation of K-wiring favoured patients with distal radius fracture, even though there was no metaphyseal comminution, and therefore is suggested in contrast to plaster supplementation.

Kirschner’s Wires Fixation of Unstable Distal Radius Fractures in Children with the Kapandji Technique

2021 ◽  
Vol 18 (2) ◽  
pp. 4-8
Author(s):  
Sabin Shrestha ◽  
Dinesh Kumar Shrestha ◽  
Dipendra KC ◽  
Prateek Karki ◽  
Sushil Yogi
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Additional Tool ◽  
Fractures In Children ◽  
Wire Fixation ◽  
K Wires ◽  
Unstable Distal Radius Fracture

Introduction: Unstable distal radius fractures in children have more tendencies to get displaced with conservative management resulting into deformity. This Kapandji technique of K-wire fixation is on rise to reduce and maintain these fractures in recent days. Aims: The aim of this study was to evaluate the effectiveness of the K-wires fixation in unstable distal radius fracture with Kapandji techniques. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke in unstable distal radius fracture in children with K-wires fixation using Kapandji method. Results: Twenty eight unstable distal radius fractures in children between 6 to 14 years of age were treated with one intrafocal K-wire and one or two extra focal K-wires to augment fixation. Immobilization of forearm with above elbow slab/cast for four to six weeks was enforced. K-wires were removed between four to six weeks of operation depending upon the union and followed prospectively for four months. The mean age of patients presented was 8.57± 1.79 years. This technique brought near anatomical reduction in all fractures. There was no reduction loss or remanipulation in any case. All fractures achieved union and functional outcome was excellent in 24 cases based on Modified Mayo Wrist Score. There was fewer complications like pin tract infection. Conclusion: This Kapandji technique of K-wire fixation, leverage reduction method, being an additional tool helps to achieve near anatomical alignment, and maintain reduction throughout the duration of healing. So it is an advantageous technique.

scholarly journals A COMPARATIVE STUDY OF VOLAR LOCKING PLATE VERSUS EXTERNAL FIXATION FOR DISPLACED INTRAARTICULAR DISTAL END RADIUS FRACTURES AT ORTHOPAEDICS DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

2021 ◽  
pp. 1-3
Author(s):  
Kunal Shankar ◽  
Vikash M. Harinandan ◽  
Laljee Chaudhary ◽  
Debarshi Jana
Keyword(s):  
External Fixation ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
External Fixator ◽  
Locking Plate ◽  
Plate Versus ◽  
Radius Fracture ◽  
Volar Locking Plate ◽  
Radius Fractures

Background: Distal radius fracture is more common accounting for 1/6th of the all fractures. With this background, this study was carried out to compare the functional outcome of volar locking plate and external fixator to the displaced intra-articular distal end radius fractures using Modified Mayo Wrist Score (MMWS). Materials and methods: This study included those patients with distal radius fracture attending the Orthopaedic Department of DMCH, Laheriasarai, Bihar, during January 2019 to December 2019. Patients were randomised based on - even and odd day of the week. This included two set of group with twenty patients in each group- one with volar locking plating and other with external fixation. Patients were followed up at 6 months and 1 year. At each follow up, the pain and range of movements were assessed by MMWS score which was entered in Microsoft excel and analysed in SPSS 20. Results: At the end of one year after surgery, we observed that external fixation technique was superior for treating displaced intra-articular comminuted distal end radius fractures than volar locking plate. Conclusion: External fixator showed more advantageous than volar locking plates after 1year of follow up.

Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis

Hand ◽  
2021 ◽  
pp. 155894472199973
Author(s):  
Nicholas Munaretto ◽  
Adam Tagliero ◽  
Raahil Patel ◽  
Peter C. Rhee
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Functional Classification ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Ipsilateral Hemiparesis

Background Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia. Methods Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union. Results There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries. Conclusions Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.

scholarly journals Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051987956
Author(s):  
Pengfei Cheng ◽  
Fan Wu ◽  
Hua Chen ◽  
Chaoyin Jiang ◽  
Ting Wang ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Fixation ◽  
Scale Score ◽  
Distal Radius ◽  
Visual Analog Scale Score ◽  
Dash Score ◽  
Radius Fractures ◽  
Analog Scale ◽  
Radial Inclination ◽  
K Wires

Objective We evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series. Methods Sixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively. Results The volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics. Conclusions Hybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients. Clinical Study registration number ChiCTR1900021712

scholarly journals A study of Kapandji intrafocal pinning for the treatment of unstable extra articular distal radius fractures

2017 ◽  
Vol 7 (2) ◽  
pp. 28-32
Author(s):  
Titjhendra Khadka ◽  
Rudra Prasad Marasini ◽  
Dirgha Raj KC ◽  
Rojan Tamrakar ◽  
Prakash Bahadur Thapa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Full Range ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Point System ◽  
Functional Evaluation ◽  
Kirschner Wires ◽  
Radius Fractures

Intrafocal pinning of distal radius fracture is indicated in unstable distal radius fractures without significant intra-articular displacement. It is a simple and effective, minimally invasive method of fixation for achievement of alignment and stability of unstable fractures. The study was conducted between November 2013 and October 2016. Patients attending the emergency and outpatient departments with history of trauma followed by pain and swelling of wrist, were evaluated clinically & radiologically. Patients with distal radius fracture who met the criteria were enrolled in the study. The operation was performed either under regional anaesthesia or intra venous anaesthesia. Reduction was carried out under image intensifier guidance and intrafocal pinning was undertaken with 2 Kirschner wires as described by Kapandji. Above elbow slab was applied for 3 weeks. Kirschner wires were removed at 6th week. Follow ups were done with radiological and functional evaluation on 1st week, 3rd week, 6th week, 12th week and 6 month. Of the 30 cases enrolled in our study, the age ranged from 40 to 72 years and the mean age of the patients was 54.77 years. The female/male ratio was 5:1 and the majority (83%) of patient sustained injury due to trivial trauma. All fractures united by 6 weeks. In the final follow up at 6th month, assessment of range of motion showed almost full range of motion. Functional evaluation was carried out with Gartland & Werleys Demerit point system (modified by Sarmiento et al). According to the score, 9 patients had excellent, 19 had well and 2 had fair results. None of the patient had poor results. Kapandji intrafocal pinning provides a stable fixation and good functional outcome in extraarticular distal radius fractures with few complications only.

scholarly journals Functional Outcomes Following Fixation of an Ultra-distal Radius Fracture with Two Commonly used Volar Locking Plates: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yin-Ming Huang ◽  
Chun-Yu Chen ◽  
Kai-Cheng Lin ◽  
Yih-Wen Tarng ◽  
Ching-Yi Liao ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Mayo Wrist Score ◽  
Patient Reported

Abstract Introduction: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, ultra-distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on ultra-distal radius fractures. This study compared functional outcomes in patients with ultra-distal radius fractures treated with two different implants.Materials and Methods: A retrospective study was conducted, all patients who received a Synthes 2.4mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The ultra-distal fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. Results: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and gripping strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). Conclusions: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating ultra-distal radius fractures.

scholarly journals Simultaneous Fractures of the Ipsilateral Scaphoid and Distal Radius

2018 ◽  
Vol 07 (04) ◽  
pp. 303-311 ◽  
Author(s):  
Elizabeth Fitzpatrick ◽  
Timothy Fowler
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Scaphoid Fracture ◽  
High Energy ◽  
Fracture Pattern ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures ◽  
Scaphoid Fractures

Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches. Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously. Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied. Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment. Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management. Level of Evidence Therapeutic level IV study.

scholarly journals The Use of Phalangeal Plate as “Hook Plate” to Treat Unstable Distal Radius Fracture Fragments with External Fixation

2021 ◽  
Author(s):  
Feng Gang ◽  
Xiangfeng Zhang ◽  
Edem Prince Ghamor-Amegavi ◽  
Hejia Hu
Keyword(s):  
Functional Outcome ◽  
External Fixation ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Hook Plate ◽  
Radius Fracture ◽  
Active Motion ◽  
Excellent Outcome ◽  
Good Score

Abstract Background: To study the functional outcome of AO type C3 distal radius fracture using external fixation and modified radial flexor carpi approach with contoured phalangeal plate as “hook plate” to treat small comminuted and unstable fracture fragments.Method: Between June 2016 and October 2017, seven patients presenting with AO type C3 distal radius fracture were treated using modified radial flexor approach and external fixation. Radiographic assessment were based on preoperative and postoperative X-ray and CT imaging during follow-up visits. The grip strength, range of active motion and pain were recorded. Mayo writs score and Gartland and Werley score were obtained to evaluated functional outcome.Results: The mean follow-up was 2 years. All patients achieved articular congruity and bone healing. The average Gartland and Werley score was 2.86 which indicated excellent outcome with minimal impairment to daily life. The average Mayo score was 87.5 which overall was a good score, 3 patients (42.9%) had excellent score and 4 patients (57.1%) had good score. No complications such as radioulnar instability and implant failure occurred.Conclusion: Our results suggest rapid functional outcome and range of motion at the wrist with minimal complications. This technique is effective and addresses the challenges in treating unstable AO type C3 distal radius fracture. Installing the external fixator first provides adequate reduction and enhances stability while the bent phalangeal plate serves as a buttress to grab and fix small fracture fragments.

Influence of Smoking in the Clinical Outcomes of Distal Radius Fractures

2020 ◽  
Author(s):  
Ayaka Kaneko ◽  
Kiyohito Naito ◽  
Hiroyuki Obata ◽  
Nana Nagura ◽  
Yoichi Sugiyama ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Bone Healing ◽  
Fracture Fixation ◽  
Healing Process ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Radius Fractures

Abstract Introduction There are various studies that reviewed the effect of cigarette smoking in fracture healing process. Nonunion, delayed union, and residual pain are the significant risk factors associated with smoking and fracture healing. Little has been known about the impact of smoking in distal radius fracture healing. We intend to explore in brief the effect of smoking in distal radius fracture healing and comparing it with nonsmokers having the same fracture fixation and analyze the outcomes with respect to fracture healing and return of function. Materials and Methods Of the total 186 patients, 92 were included in the study with (n = male: 31, female: 61) mean age of 60.2 years. They were divided into two groups: smoking (n = 43) and nonsmoking (n = 49). All had surgical fixation of the distal radius with volar locking plate and started on early mobilization. The range of motion of the wrist, grip, visual analog scale, quick disabilities of the arm and shoulder and hand score, Mayo wrist score, and bone healing period were noted between these two groups and compared with statistical analysis. Results The mean follow-up period was 8.7 months. There was a significant association of young age and male patients having distal radius fractures in the smoking group (p < 0.05). All fractures healed well in both groups without complications. There was no significant difference between these two groups in terms of range of motion, grasp, bone healing period, and functional outcomes. Conclusion Despite the well-known fact that, smoking has negative implications in the fracture healing process, we found group of patients (smoking and nonsmoking) with distal radius fractures treated by volar locking plates healed well with good radiological union and excellent functional outcome There is no significant influence of smoking in distal radius fracture fixation.

scholarly journals The Role of Additional K-Wires on AO Type C Distal Radius Fracture Treatment with External Fixator in Young Population

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Ivan Micic ◽  
Erica Kholinne ◽  
Yucheng Sun ◽  
Jae-Man Kwak ◽  
In-Ho Jeon
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
External Fixator ◽  
Critical Role ◽  
Radius Fracture ◽  
Significant Difference ◽  
Type C ◽  
K Wires

Objectives. Several methods have been proposed to treat AO type C distal radius fracture. External fixator has gained popularity for its simple procedure and rapid recovery. Some surgeons suggested that additional K-wires may play a critical role in the outcome. The purpose of study is to evaluate the role of additional K wires in treating distal radial fracture with external fixator regarding its outcome. Material and Methods. From January 2006 to January 2010, 40 patients with AO type C distal radius fracture were treated with external fixator, with (EF) or without additional K wires (EFK). Radiologic outcome parameters include radial inclination, volar tilt, radial length, and the presence of radiocarpal arthritis according to Knirk and Jupiter. Clinical outcomes include New York Orthopedic Hospital (NYOH) wrist scoring scale. Results. Radiographic outcome showed significant difference in regard of articular congruency at the final follow-up with the EFK group showing the advantage in maintaining the articular incongruity. NYOH wrist scoring scale showed no significant difference between both groups at final follow-up. The amount of articular step-off was less in EFK group with significant statistical finding on the final follow up. Conclusion. Both EF and EFK technique were able to provide satisfactory result in treating AO type C distal radius fractures. We observed that EFK is superior in reducing the number of radiocarpal arthritic changes compared to EF group due to its superiority in reducing articular step-off.

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