Combined Kirschner wire fixation in the treatment of Colles fracture

Abstract

For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. The analysis of a collective of 110 fractures including a clinical and radiological follow-up examination of 72 patients revealed good anatomical reconstruction of the distal radius. The loss of motion was minimal on average and consistent with a good wrist function. Major restrictions resulted from stress-dependent pain as a consequence of posttraumatic arthritis or algodystrophy. A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.

Estudo da relação anatômica do nervo sensitivo radial após fixação percutânea com fios de Kirschner

“…A distância entre o fio de Kirschner localizado no processo estilóide do rádio e os tendões do primeiro te nas fraturas dos tipos A2, A3, B1 e algumas do tipo C da classificação AO, porém, está contra-indicada nas fraturas gravemente cominuídas ou osteoporóticas, devido ao osso trabecular da região metafisária apresentar pouca estabilidade (2,(12)(13)(14) . A técnica de introdução de fios de Kirschner através do processo estilóide do rádio foi descrito primeiramente por Lambotte, em 1913, segundo Clancey (15) .…”

“…A técnica de introdução de fios de Kirschner através do processo estilóide do rádio foi descrito primeiramente por Lambotte, em 1913, segundo Clancey (15) . Fritz et al relataram freqüentes aplicações da osteossíntese com fio de Kirschner em pacientes idosos (12) . Clancey relatou bons resultados após osteossíntese com fios de Kirschner, mas seus melhores resultados foram em pacientes jovens (15) .…”

Prospective study of treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji's method of intrafocal pinning anatomically and functionally

“…The initial reduction was maintained for more than five weeks in only 29% of the patients and suggested Kirschner wire osteosynthesis is mainly indicated for Colles's fractures located close to the joint (AO types A2 and A3). 12 Fritz et al 13 reported application of Kirschner wire in elderly patients. Clancey 14 reported good results after Kirschner wire osteosynthesis.…”

Distale Radiusfraktur

“…Den noch hat sich in den letz ten Jah ren auf grund der Er geb nis se pro spek ti ver Ko hor tenstu di en ein brei ter Kon sens be tref fend der Be hand lungs zie le -ana to mi sche Wie der her stellung in en gen Gren zen, "Funk ti on folgt der Form" -und der An wen dung be stimm ter konser va ti ver, mi ni malin va si ver, of fe ner und kom bi nier ter Be hand lungs ver fah ren er ge ben [5,7,12,15,17,21].…”

“…Zahl rei che kli ni sche Stu di en [1,7,12] zeig ten, dass das Ent ste hen ei nes chro nisch regio na len Schmerz syn droms mit der Zahl von Ein rich tungs ma nö vern ex po nen ti ell ansteigt.…”