Closed Reduction, Percutaneous Kirschner Wire Fixation and Cast Immobilisation of Distal Radius Fracture- A Prospective Observational Study

Title: Closed Reduction, Percutaneous Kirschner Wire Fixation and Cast Immobilisation of Distal Radius Fracture- A Prospective Observational Study

Authors: Abhishek Kalantri, Sunil Barod, Dilip Kothari, Archana Kothari, Pawan Bhambani

DOI: https://dx.doi.org/10.18535/jmscr/v5i6.150

Abstract

Background: Distal radius fractures are the most common type of orthopedic fracture. Some orthopedic surgeons prefer treatment by manipulation and plaster immobilization. Majority recommend operative intervention as the only methods to obtain anatomical reduction, and some have proposed that the best functional result will only be achieved by obtaining as near an anatomical radiographic result as possible. Objectives: To study effectiveness of Kirschner wire fixation with and cast immobilization for patients with fracture of the distal radius.

Methodology: About 54 patients with with displaced fractures of the distal third of the radius with or without ulnar fractures were managed by closed reduction and percutaneous Kirschner-wire fixation. 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. After reduction and fixation the arm was immobilized in a cast above the elbow with the forearm and wrist in neutral position. Kirschner wire was removed after six weeks, followed by support with a wrist splint.

Results: The majority patients with distal radial fracture were men (75.9%). Majority of the patients (72.2%) sustained the injury due to fall. The side of involvement was more on right side (57.4%). Their average age was 29.3 years (18- 63 years). Antegrade intramedullary Kirschnerwire fixation was done for distal radial fractures in 70.4% of cases. Patients were evaluated clinically and radiologically after an average duration of follow-up of 9 months (due to time constrain for the study). In our study, according to AO classification, 29 cases were of Type A, 12 were of Type B and 3 were of Type C. The Anatomical evaluation by Sarmiento’s Criteria showed 20 (37.03%) patients with excellent, 14 patients with good, 8 with a fair and 2 with a poor result or outcome respectively. At final follow-up by ‘The Gartland & Werley Criteria for Functional Outcome’ 27 patients had excellent result, 12 had good result, 4 had fair result and 1 had a poor result.

Conclusion: This study demonstrates that percutaneous Kirschner wire pinning and cast immobilization is a minimally invasive technique that provides an effective means of maintaining the anatomical fracture reduction for distal radius fracture. The technique involves a minimal procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.

Keywords: Distal radius fracture, Close reduction, Percutaneous Kirschner wire fixation, Cast immobilization.

References

1. Colles A. On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 2006; 445:5-7.

2. Frykman G. Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand 1967:Suppl 108:3+.

3. Melone CP, Jr. Open treatment for displaced articular fractures of the distal radius. Clin Orthop Relat Res 1986-202:103-11.

4. Muller ME, Nazarian S, Koch P. AO Classification of fractures. Springer-Verlag, Berlin, 1987.

5. Leung F, Kwan K, Fang C. Focus on distal radius fracture: current concepts and management. The British Editorial Society of Bone and Joint Surgery 2013. Available at http://www.boneandjoint.org.uk/content/focus/distal-radius-fracture-current-concepts-and-management [Accessed on 19th Feb 2017].

6. Pogue DJ, Vegas SF, Patterson RM, Peterson PD, Jenkins DK, Sweo TD, et al. Effects of distal radius malunion on wrist joint mechanics. J Hand Surg Am. 1990; 15:721–7.

7. Souer JS, Lozano-Calderon SA, Ring D. Predictors of wrist function and health status after operative treatment of fractures of the distal radius. J Hand Surg Am 2008 Feb; 33(2):157-163.

8. Cooney WP. Fractures of the distal radius. A modern treatment-based classification. Orthop Clin North Am 1993 Ap; 24(2):211-6.

9. Burton EM, Brody AS. Musculoskeletal system. Essentials of Pediatric Radiology. New York, NY: Thieme Medical Pubs; 1999: 221-8.

10. Maschke SD, Evans PJ, Schub D, Drake R, Lawton JN. Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (N Y) 2007 Sep; 2(3):144-50.

11. Lill CA, Goldhahn J, Albrecht A, Eckstein F, Gatzka C, Schneider E. Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications. J Orthop Trauma. 2003 Apr; 17(4):271-8.

12. Belloti JC, Tamaoki MJ, Franciozi CE, Santos JB, Balbachevsky D, Chap Chap E. Are distal radius fracture classifications reproducible? Intra and interobserver agreement. Sao Paulo Med J 2008 May 1; 126(3):180-5.

13. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004 Nov; 29(6):1128-38.

14. Henry MH. Distal radius fractures: current concepts. J Hand Surg Am 2008 Sep; 33(7):1215-27.

15. ozentka DJ, Beredjiklian PK, Westawski D, et al. Digital radiographs in the assessment of distal radius fracture parameters. Clin Orthop Relat Res. 2002 Apr. (397):409-13.

16. Johnston GH, Friedman L, Kriegler JC. Computerized tomographic evaluation of acute distal radial fractures. J Hand Surg [Am]. 1992 Jul. 17(4):738-44.

17. Rogers LF. Traumatic Lesions of Bones and Joints. Juhl JH, Crummy AB, eds. Paul and Juhls' Essentials of Radiologic Imaging. 6th ed. Philadelphia, Pa: JB Lippincott; 1993. 33-64.

18. Spence LD, Savenor A, Nwachuku I. MRI of fractures of the distal radius: compa-rison with conventional radiographs. Skeletal Radiol. 1998 May. 27(5):244-9.

19. A Porrino JA, Jr. Distal Radial Fracture Imaging. Available at http://emedicine.medscape.com/article/398406-overview [Accessed on 19th Feb 2017].

20. Suojärvi N, Sillat T, Lindfors N, Koskinen SK. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images. Skeletal Radiol. 2015 Dec. 44 (12):1769-75.

21. Keats TE, Sistrom C. Atlas of Radiologic Measurement. 7th ed. Philadelphia, Pa: Harcourt Health Sciences; 2001. 186-99.

22. Downing ND, Karantana A. A revolution in the management of fractures of the distal radius? J Bone Joint Surg Br. 2008 Oct. 90(10):1271-5.

23. Suhm N, Gisep A. Injectable bone cement augmentation for the treatment of distal radius fractures: a review. J Orthop Trauma. 2008 Sep. 22(8 Suppl):S121-5.

24. Lakshmanan P, Dixit V, Reed MR, Sher JL. Infection rate of Krischner wire fixation for distal radius fracture. J Orthop Surg (Hong Kong) 2010; 18:85-6.

25. Lidstrom A. Fracture of the distal end of the radius. A clinical and statistical study of end results, Acta Orthop Scand Suppl. 1959; 41:1-118.

26. Gartland JJ. Jr, Werley CW. Evaluation of healed Colles’ fracture, J Bone Joint Surg Am 1951 Oct; 33-A(4):895-907.

27. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Jt Surg Am. 1986; 68:647–59.

28. Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19:325–40.

29. Chen CE, Juhn RJ, Ko JY. Treatment of distal radius fractures with percutaneous pinning and pin-in-plaster. Hand (N Y). 2008 Sep;3(3):245-50.]

30. Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of Distal Radius: An Overview. Journal of Family Medicine and Primary Care. 2014;3(4):325-332.

31. Havemann D, Busse FW. Accident mechanisms and classifications in distal radius fractures. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990:639–42.

32. Stewart HD, Innes AR, Burke FD. Factors affecting the outcome of Colles’ fracture: an anatomical and functional stud. Injury 1985; 16:289–95.

33. McQueen M, Caspers J. Colles’ fracture: does the anatomical result affect the final function? J Bone JtSurg Br. 1988; 70:649–51.

34. Munson GO, Gainor BJ. Percutaneous pinning of distal radius fractures. J Trauma. 1981 Dec;21(12):1032-5.

35. Koval KJ, Zuckerman JD, Kenneth E. 2nd ed. Philadelphia, USA: Lippincott williams and Wilkins; Handbook of Fractures; pp. 133–8.

^36.Weil WM, Trumble TE. Treatment of distal radius fractures with intrafocal pinning and supplemental skeletal stabilization. Hand Clin. 2005;21:317–28

37. Chattopadhyay A, Banerjee U, Sinha PK, Misra S, Chattopadhyay A, Veeragandham P. A prospective study of distal radius fracture management by close reduction, percutaneous Kirschner wire fixation and plaster immobilization. Int J Res Orthop 2017; 3:537-44.

38. Uzzaman KS, Awal KA, Alam MK. Closed reduction and percutaneous kirschner wire fixation combined with plaster cast versus conventional plaster cast immobilization in the treatment of colles’ fracture – a prospective randomized comparative study. J Dhaka Med Coll. October 2008; 17 (2): 98-105.

39. Solomon L, Warwick D, Nayagam S. 9th ed. Florida: CRC press; 2001. Apley's System of Orthopaedics and Fractures; pp. 615–8.

40. Fu YC, Chien SH, Huang PJ, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma. 2006; 60:330–3.

41. Clancey GJ. Percutaneous Kirschner-wire fixation of Colles fractures—a prospective study of thirty cases. J Bone Jt Surg Am. 1984; 66:1008–14.

42. Clancey GJ. Percutaneous Kirschner wire fixation of Collesfarcture. J Bone Joint Surg Am 1984; 66:1008-14.

43. Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fracture of the distal end of the radius: Arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 1999; 81: 1093-110.

44. Akhter Baig MB, Ahmed K, Humail SM. Closed reduction and percutaneous Kirschner wire fixation of displaced Colles fracture in adults. Pakistan Journal of Surgery 2008; 24(1):31-37.

45. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Joint Surg [Br] 2005;87-B:837-40.

46. Zyluk A, Janowski P. A comparison of the results of the conservative vs operative by percutaneous Kirschner-wiring treatment of fractures of the distal radius. Chir Narzadow Ruchu Ortop Pol 2007; 72:327-34 (in Polish).

47. Wong TC, Chiu Y, Tsang WL, et al. Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial. J Hand Surg Eur Vol 2010;35:202-8.

48. Handoll HH, Vaghela MV, Madhok R. Percutaneous pinning for treating distal radial fractures in adults. Cochrane Database Syst Rev 2007;3:CD006080.

49. Egol K, Walsh M, Tejwani N, et al. Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial. J Bone Joint Surg [Br] 2008; 90-B: 1214-21.

50. Hargreaves DG, Drew SJ, Eckersley R. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. J Hand Surg Br 2004; 29:374-6.

51. Ritting AW, Wolf JM. How to measure outcomes of distal radius fracture treatment. Hand Clin 2012; 28:165-75.

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Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

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Submission of Articles