scholarly journals A prospective study of distal radius fracture management by close reduction, percutaneous Kirschner wire fixation and plaster immobilization

Author(s):  
Abhishek Chattopadhyay ◽  
Upal Banerjee ◽  
Prashant Kumar Sinha ◽  
Subarna Misra ◽  
Ananya Chattopadhyay ◽  
...  

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal radius fracture is one of the most common fractures. It may be sustained due to low-energy trauma or high-energy trauma. Objectives: To compare the clinical effectiveness of Kirschner wire fixation with and plaster immobilization for patients with fracture of the distal radius.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. About 79 patients with Distal Radial Fractures presented to MGM Medical College and LSK Hospital, Kishanganj between November 2012 and June 2014 were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority were men (60.4%). Majority of the patients (69.8%) sustained the injury due to fall. The side of involvement was nearly equal and that there was no predominance of the either sides. In our study, according to AO classification, 31 cases were of Type A, 17 were of Type B and 5 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 33 patients with excellent result, 15 patients with good result and 5 with a fair result. At final follow-up by ‘The Gartland and Werley criteria for functional outcome’ 37 patients had excellent result, 13 had good result, 2 had fair result and 1 had a poor result. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This study demonstrates that percutaneous Kirschner<strong> </strong>wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical<strong> </strong>fracture reduction. It does not required highly skilled<strong> </strong>personnel or sophisticated tools for application. It is a<strong> </strong>suitable method for fixation of displaced Colles fracture with minimal intra-articular involvement. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.</span></p>

Author(s):  
Tanveer Ali ◽  
Mohmmad Sikander Baketh ◽  
Maneer Ahmad Mir

Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical  restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that  provides anatomic  reduction,  fracture  fixation,  and maintenance  of  reduction  with  an  adequate method of  immobilization.


2015 ◽  
Vol 19 (17) ◽  
pp. 1-124 ◽  
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Caroline Plant ◽  
Nick R Parsons ◽  
Amar Rangan ◽  
...  

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.


2021 ◽  
Vol 18 (2) ◽  
pp. 4-8
Author(s):  
Sabin Shrestha ◽  
Dinesh Kumar Shrestha ◽  
Dipendra KC ◽  
Prateek Karki ◽  
Sushil Yogi

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.


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