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.
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