Comparative Assessment of Functional Outcomes of Surgical Treatment in Patients with Distal Radial Fractures

2021 ◽  
Vol 23 (6) ◽  
pp. 401-410
Author(s):  
Jakub Florek ◽  
Filip Georgiew ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Grip Strength ◽  
Sagittal Plane ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Distal Radial Fractures ◽  
Fixation Group ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Background. Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kir­schner wires, open reduction and fixation with a non-locking or locking plate or with an external device. The aim of this paper was to try to answer the following question: are there differences in functional treatment outcomes in patients after surgery with the use of Kirschner wires vs LCP plate fixation? Material and methods. The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires (50 patients) and by open reduction and LCP locking plate fixation (50 patients). The study assessed the following parameters: global grip strength, pain severity in a VAS scale, range of motion, functional status of the wrist based on the Fernandez classification, quality of life according to the QuickDASH score, and the frequency of complications. These parameters were assessed at 6 and 12 months after surgery. Results. An assessment of the treatment outcomes at 6 and 12 months after surgery showed statistically significant differences between the treatment methods in the following parameters: pain severity, global grip strength and range of motion in the sagittal plane. A comparison of the functional status of the wrist at 6 and 12 months between the groups showed considerably worse results in the Kirschner wire fixation group. The frequency of postoperative complications at 12 months was 6% in the Kirschner wire fixation group and 2% in the LCP plate fixation group. Conclusions. 1. Treatment outcomes were better in patients with distal radial fractures managed with LCP plate fixation. 2. The use of LCP plate fixation predisposes pa­tients to better ranges of mobility in the sagittal plane in the radiocarpal joint. 3.The values of global grip strength were higher in the group treated with LCP plate fixation. 4. Patients treated with LCP plates have better limb function and quality of life and lower pain intensity after treatment completion. 5. The number of complications was higher in pa­tients treated with Kirschner wire fixation.

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.

Comparison of Radiographic Outcomes of Surgical Treatment in Patients with Distal Radial Fractures

2018 ◽  
Vol 20 (6) ◽  
pp. 461-470
Author(s):  
Jakub Florek ◽  
Ireneusz Kotela ◽  
Filip Georgiew ◽  
Witold Zieńczuk ◽  
Tomasz Rzeszutek
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Locking Plate ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Treatment Method ◽  
Kirschner Wires ◽  
Distal Radial Fractures ◽  
Efficient Treatment ◽  
Radiographic Outcomes

Background. Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kirschner wires, open reduction, and fixation with a non-locking or locking plate or with an external device. Choosing a surgical method that produces “better” outcomes may help select the most efficient treatment method. Material and methods. The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires and by open reduction and LCP locking plate fixation. Radiographic assessment was based on images obtained before the surgery, immediately after fracture reduction, and at 6 weeks, 6 months, and 12 months after the procedure. Results. A comparison of the volar tilt angle in patients after fixation with Kirschner wires and LCP plates did not show any statistically significant differences before the surgery or at 6 weeks. A difference in the outcomes was found at 6 and 12 months and it turned out to be highly statistically significant. A comparison of the inclination angle and radial height in patients after Kirschner wire and LCP plate fixation showed statistically significant differences at 6 weeks, 6 months, and 12 months. A comparison of the radiographic outcomes using the Sarmiento classification in patients after Kirschner wire and LCP plate fixation revealed statistically significant differences at all follow-up time points. Conclusions. The radiographic parameters were superior in patients treated by open reduction and LCP plate fixation. The difference was seen with regard to all the parameters studied.

Outcome of Proximal Chevron Osteotomy for Hallux Valgus With and Without Transverse Kirschner Wire Fixation

2008 ◽  
Vol 29 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Keun-Bae Lee ◽  
Chang-Young Seo ◽  
Chang-Ich Hur ◽  
Eun-Sun Moon ◽  
Jae-Jun Lee
Keyword(s):  
Hallux Valgus ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Fixation Group ◽  
Chevron Osteotomy ◽  
Kirschner Wire Fixation ◽  
Group I ◽  
Wire Fixation ◽  
Group Ii ◽  
Severe Hallux Valgus

Background: Proximal chevron osteotomy (PCO) for hallux valgus is inherently more stable than the other forms of proximal metatarsal osteotomy, but complications, such as, delayed union, nonunion, and malunion can occur. In this study, we have compared results of two axial Kirschner wire fixation with or without transverse Kirschner wires in PCO for moderate to severe hallux valgus deformities. Methods: A prospective study was conducted on 65 patients (85 feet) that underwent PCO and a distal soft tissue procedure for moderate to severe hallux valgus. Patients were divided into two groups, two axial Kirschner wire fixation (Group I) and two axial and supplementary transverse Kirschner wire fixation (Group II). Group I comprised 41 feet of 32 patients and Group II 44 feet of 33 patients. Results: Average AOFAS scores were 52.8 points in group I and 49.6 points in group II preoperatively, and 92.8 and 89.6 points, respectively, at last followup. Patients were very satisfied or satisfied in 92.7% in Group I and 93.2% in Group II. Average hallux valgus angles in Groups I and II changed from 34.9 degrees and 37.2 degrees preoperatively to 12.3 degrees and 13.9 degrees postoperatively, and intermetatarsal angles in Groups I and II changed from an average of 17.9 degrees and 17.2 degrees preoperatively to 10.3 degrees and 10.4 degrees postoperatively. No significant inter-group differences were found. Conclusion: Supplementary transverse Kirschner wire fixation is not recommended for proximal metatarsal chevron osteotomy since two axial Kirschner wires provided sufficient stability. Level of Evidence: I, Prospective Radomized Study

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.

Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

2011 ◽  
Vol 1 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel A Wartinbee ◽  
Michael Miller ◽  
Jonathan Riboh
Keyword(s):  
Grip Strength ◽  
External Fixation ◽  
Distal Radius ◽  
Plate Fixation ◽  
Volar Plate ◽  
Complication Rates ◽  
Distal Radial Fractures ◽  
Fixation Group ◽  
Vas Scores ◽  
Volar Plate Fixation

ABSTRACT Background Much attention has been given recently to the complication profile of volar plate fixation of distal radial fractures. The purpose of this investigation was to compare complication rates among patients with distal radial fractures treated with volar plating versus those treated with external fixation. Methods Two parallel series of patients with comminuted intra-articular distal radius fractures were reviewed. 59 patients were treated with external fixation and 56 patients with volar plate fixation. Postoperative radiographs, range of motion, grip strength, DASH scores, and VAS pain questionnaires were analyzed, and complications were described. Results The external fixation group had a significantly higher overall complication rate (p = 0.021) than the volar plate fixation group. In the volar plate group, there were more tendon complications and median nerve pathology. Radial shortening was greater in the external fixation group when compared to the volar plate fixation group. DASH scores and VAS scores were significantly higher in the external fixation group. Clinically, the patients in the volar plate fixation group had significantly greater arcs of motion in pronation-supination (p < 0.0001) and flexion-extension (p = 0.002) with a trend towards better grip strength (p = 0.0062). Conclusions Volar plate fixation for fractures of the distal radius provides an overall decreased incidence of complications, significantly less radial shortening, and significantly greater postoperative wrist motion when compared to external fixation. Volar plate fixation is also associated with lower VAS scores when compared to external fixation as well as DASH scores that approach statistical significance. Level of evidence III (retrospective comparative study).

Results of small-joint arthrodesis: Comparison of Kirschner wire fixation with tension band wire technique

1992 ◽  
Vol 17 (5) ◽  
pp. 952-956 ◽  
Author(s):  
C.B. Ijsselstein ◽  
D.B. van Egmond ◽  
S.E.R. Hovius ◽  
J.C. van der Meulen
Keyword(s):  
Kirschner Wire ◽  
Tension Band ◽  
Tension Band Wire ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Small Joint
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