Displaced Distal Radius Fracture in Children, Single vs Double K-Wire Fixation

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation