DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20171898

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

Abhishek Chattopadhyay, Upal Banerjee, Prashant Kumar Sinha, Subarna Misra, Ananya Chattopadhyay, Prasad Veeragandham

Abstract


Background: 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.

Methods: 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.

Results: 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.

Conclusions: This study demonstrates that percutaneous Kirschner wire pinning is a minimally invasive technique that provides an effective means of maintaining the anatomical fracture reduction. It does not required highly skilled personnel or sophisticated tools for application. It is a 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.


Keywords


Distal radius fracture, Close reduction, Percutaneous Kirschner wire fixation, Plaster immobilization

Full Text:

PDF

References


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.

Meena S, Sharma P, Sambharia AK, Dawar A. Fractures of Distal Radius: An Overview. J Family Med Prim Care. 2014;3(4):325-32.

Koval KJ, Zuckerman JD, Kenneth E. 2nd ed. Philadelphia, USA: Lippincott williams and Wilkins; Handbook of Fractures; 2001: 133–138.

Solomon L, Warwick D, Nayagam S. 9th ed. Florida: CRC press. Apley's System of Orthopaedics and Fractures; 2001: 615–618.

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

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

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

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

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

Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am. 2000;25:19–28.

Fu YC, Chien SH, Huang PJ, Chen SK, Tien YC, Lin GT, 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.

Jenkins NH, Mintowt-Czyz WJ. Mal-union and dysfunction in Colles’ fracture. J Hand Surg Br. 1988;13:291–3.

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

Ruch DS. Fractures of the distal radius and ulna. Rockwood and Green’s fractures in adult. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 913–918.

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.

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

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. 2008;17(2):98-105.

Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles’ fractures—functional bracing in supination. J Bone Jt Surg Am. 1975;57:311–7.

Spira E, Weigl K. The comminuted fracture of the distal end of the radius. Reconstr Surg Traumatol. 1968;11:128–38.

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

Madhukar K T, Gopalkrishna G, Mohan JA. Percutaneous K-wire fixation of distal radius fractures: Our results of leaving the wire outside. Int J Health Allied Sci 2013;2:23-9.

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.

Akhter Baig MB, Ahmed K, Humail SM. Closed reduction and percutaneous Kirschner wire fixation of displaced Colles fracture in adults. Pak J Surg. 2008;24(1):31-7.

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