A COMPARATIVE STU DY BETWEEN “CLOSED REDUCTION, CAST IMMOBILISATION “AND “CLOSED REDUCTION, PERCUTANEOUS K - WIRE FIXATION, CAST IMMOBILISATION” IN DISTAL RADIUS FRACTURES

Background: Distal radius fractures are common and traditionally these injuries are treated non-operatively. Percutaneous wiring has been recommended as simple method to provide extra stability in distal radius fractures but their exact role is uncertain. The aim of this study was to retrospectively compare the radiographic and functional outcomes following cast immobilisation and those following wire fixation in the management of distal radius fractures and investigate which method produced better outcomes.Methods: A retrospective parallel case series was performed between April 2011 and April 2013 of patients over 50 years treated with either cast immobilisation or wire fixation. Both intra- and extra-articular fractures were included. Radiographic measurements were made pre-operatively and at three months follow up. The QuickDASH was recorded by postal questionnaire at a mean of 2 years.Results: 159 patients were included; 85 cast immobilisation group and 74 wire fixation group. Improvement in radiological parameters was seen in both groups but this was significantly better after wire fixation ([Formula: see text]). QuickDASH scores were available in 64%; no significant difference in mean scores was seen after (p = 0.147); cast immobilisation 27.1 and wire fixation 26.6.Conclusions: Cast immobilisation can produce comparable functional results to wire fixation despite worse radiological outcomes.

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A Comparative Study on Functional Outcome of Distal Radius Fractures Treated with POP Cast Versus Percutaneous K-Wire Fixation (Both After Closed Reduction) In Kannur Medical College, Kerala, India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/583 ◽

2021 ◽

Vol 8 (34) ◽

pp. 3205-3210

Author(s):

Adnan Siddique P ◽

Sasikumar Sasidharan ◽

Prateek Chandak

Keyword(s):

Functional Outcome ◽

Distal Radius ◽

Closed Reduction ◽

Final Outcome ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Wire Fixation ◽

Group A ◽

Group B ◽

Methods Of Treatment

BACKGROUND Closed reduction with plaster of Paris (POP) cast for extra-articular distal radius fractures was an accepted method of treatment worldwide. But the maintenance of reduced fracture fragments was unpredictable. Closed reduction and ‘K’ wire fixation with casting was also recommended widely. There was no definite option prescribed for either of the methods. In this study, we wanted to compare the final outcome of management of the distal radius fractures in adults with closed reduction and POP casing versus closed reduction with percutaneous K-wiring. METHODS A prospective, randomized, and comparative study was conducted on the final outcome of two methods of treatment for the fractures of distal end of radius. One method (Group A of 23 patients) consisted of closed reduction and POP casing and the other (Group B of 23 patients) consisted of K-wiring under C arm (23 patients in each group). Radiological and functional parameters were compared at fixed intervals for 15 months and final outcome scores were correlated and compared using Gartland and Werley functional scoring system. RESULTS In group A, AO type 2R3A2.1 fractures were observed in 03/23 (13.04 %) patients and 04/23 (17.39 %) in Group B patients. Type 2R3A2. 2 fractures were observed in 05/23 (21.73%) of the group A patients and 07/23 of the group B patients. Type 2R3A2.3 fractures were observed in 15/23 of the group A and 12/23 (52.17%) of the group B patients. Both the methods of treatment were correlating well with the various variables. CONCLUSIONS Closed reduction with percutaneous K wiring and below elbow cast application was a simple, minimally invasive technique that provided added stability and functional outcome with respect to treatment of extra-articular distal radius fracture. The conventional method of closed reduction and POP cast was closely correlating with the K wire immobilization method. There was no significant statistical difference between the two methods in the functional outcome after treatment of distal end radius fractures. KEYWORDS Radius, ‘K’ Wire, Closed Reduction, Stable Fracture, Bone Healing and Immobilize

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Does position of the wrist during cast immobilisation in patients with distal radius fractures affect outcome?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01751-8 ◽

2021 ◽

Author(s):

Eva Anna Klazina van Delft ◽

Tamara Geertruda van Gelder ◽

Jefrey Vermeulen ◽

Niels Willem Luitzen Schep ◽

Frank Willen Bloemers

Keyword(s):

Systematic Review ◽

Distal Radius ◽

Closed Reduction ◽

Patient Reported Outcome ◽

Distal Radius Fractures ◽

Radiological Outcome ◽

Radius Fractures ◽

Cast Immobilisation ◽

Patient Reported ◽

Registration Number

Abstract Purpose The position of the wrist during cast immobilisation following closed reduction of distal radius fractures is disputed. A systematic review was initiated to assess if there was any relation between wrist position in the cast and outcome in adult patients with non-operatively treated distal radius fractures. Methods A comprehensive search was performed in the bibliographic databases Medline, Embase and Wiley/Cochrane Library from inception up to 27 November 2020. Eligible studies were: randomised controlled trials, prospective and retrospective comparative cohort studies, analysing different positions of the wrist in cast-immobilisation following closed reduction. Primary outcome of the study was functional outcome measured by range of motion. Secondary outcomes were functional outcomes measured by grip strength, patient-reported outcome, radiological outcome and complications such as secondary dislocation and pain. Results The initial search yielded 2733 studies. Five trials, with 519 patients, were included in this systematic review. Range of motion and radiological outcome was significantly better in patients who were immobilised in dorsiflexion compared to palmar flexion or neutral position, although no clinical important difference was found. There were no significant differences in patient-reported outcome, pain, grip strength or complications. Due to heterogeneity of the included studies, data were unsuitable for a meta-analysis. Conclusion This systematic review showed statistically significant better results in favour of cast immobilisation in dorsiflexion, although this small difference does not seem to be relevant in patients daily activities. Systematic review registration number Systematic review registration number: PROSPERO 2018 CRD42018085546.

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“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

10.36106/6900913 ◽

2021 ◽

pp. 29-31

Author(s):

Vibhor Khandal ◽

Ashwani Kumar Mathur ◽

Mohit Kumar ◽

Rajkumar Bairwa

Keyword(s):

Distal Radius ◽

Closed Reduction ◽

Soft Tissues ◽

Hand Function ◽

Early Mobilization ◽

Fracture Site ◽

Distal Radius Fractures ◽

Point System ◽

Casting Method ◽

Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

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Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2013.26.4.248 ◽

2013 ◽

Vol 26 (4) ◽

pp. 248

Author(s):

Ki-Chan An ◽

Gyu-Min Kong ◽

Jang-Seok Choi ◽

Hi-Chul Gwak ◽

Joo-Yong Kim ◽

...

Keyword(s):

Distal Radius ◽

Functional Outcomes ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Wire Fixation

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Outcomes of Supplementary Spring Wire Fixation With Volar Plating for Volar Lunate Facet Fragments in Distal Radius Fractures

Hand ◽

10.1177/1558944720976404 ◽

2020 ◽

pp. 155894472097640

Author(s):

Nathaniel Fogel ◽

Lauren M. Shapiro ◽

Allison Roe ◽

Sahitya Denduluri ◽

Marc J. Richard ◽

...

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Wrist Flexion ◽

Volar Plating ◽

Radius Fractures ◽

Locked Plating ◽

Spring Wire ◽

Flexion Extension ◽

Wire Fixation ◽

The Mean

Background Intra-articular distal radius fractures with small volar lunate facet fragments can be challenging to address with volar plate fixation alone. Volar locked plating with supplementary spring wire fixation has been previously described in a small series but has not been further described in the literature. We hypothesized that this technique can provide adequate fixation for volar lunate facet fragments smaller than 15 mm in length, which are at risk of displacement. Methods We completed a retrospective chart review (2015-2019) of patients who underwent volar locked plating with the addition of supplementary spring wire fixation for intra-articular distal radius fractures with a volar lunate facet fragment (<15 mm). Postoperative radiographs were assessed to evaluate union, evidence of hardware failure, escape of the volar lunate facet fragment, and postoperative volar tilt. Clinical outcome was assessed with wrist flexion/extension, arc of pronosupination, and Quick Disabilities of the Arm, Shoulder, and Hand Score ( QuickDASH) scores. Results Fifteen patients were identified, of which all went on to fracture union. There were no hardware failures or escape of the volar lunate facet fragment at final follow-up. One patient underwent hardware removal for symptoms of flexor tendon irritation. The mean wrist flexion was 59°, wrist extension was 70°, pronation was 81°, and supination was 76°. The mean QuickDASH score was 18.5. The mean postoperative volar tilt was 3.6°. Conclusions Supplementary spring wire fixation with standard volar plating provides stable fixation for lunate facet fragments less than 15 mm. This technique is a safe and reliable alternative to commercially available fragment-specific implants.

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