Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients

Abstract

The objective of this prospective, randomized, controlled trial was to compare the results of two operative techniques used for the treatment of unstable distal radius fractures in elderly patients classified as AO types A2, A3, and C1. Patients were treated with either fixed-angle volar plates or K-wires using a combined Kapandji and Willenegger technique. The functional results were determined after 3, 6, and 12 months. We included 40 patients aged over 65 years. Twenty-one patients were treated with plate fixation and 19 with K-wire fixation. The functional results, after 1 year, were nearly the same in both treatment groups, suggesting that either method is suitable for the treatment of unstable distal radius fractures of AO types A2, A3, and C1 in elderly patients. Sixteen of 21 patients with plate fixation and 17 of 19 patients with K-wire fixation present good results as assessed by the Castaing score. The median DASH score was three in both groups after 1 year. The patients with plate fixation were able to resume activities of daily living 4 weeks earlier. The most common complication was an intermediate post-traumatic median nerve irritation. Both methods are suitable for the treatment of elderly patients with unstable distal radius fractures of AO types A2, A3, and C1. If early functional post-operative care is important, palmar fixed-angle plate fixation is an ideal treatment approach. Otherwise, K-wire fixation is an effective, minimally invasive method with comparable clinical results.

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

“…There were a total of 875 participants for which these data were available. There were no differences found between K-wires and volar locking plates in terms of the PRWE score at either 3 months or final followup (6 months or 1 year) in either of the two trials that reported on this endpoint [5,12].…”

“…There were no differences in wrist extension, pronation, radial deviation, or ulnar deviation at 3 months or final followup. Wrist ROM was reported as an outcome in five trials [12,18,21,29,37], four of which reported sufficient information to enable pooling. Radial deviation and ulnar deviation were reported in only two of these trials [12,37].…”

“…According to US Medicare data, internal fixation is the most common surgical intervention for distal radius fracture in the United States, followed closely by percutaneous pinning with K-wires [3]. To our knowledge, there have been no meta-analyses comparing these two common interventions despite multiple trials on the topic having been published [5,12,18,21,29,30,37].…”

Management of Osteoporotic Patients with Distal Radial Fractures

“…Karantana et al and Goehre et al recently demonstrated that volar locked-plate fixation versus percutaneous fixation resulted in no differences in long-term functional outcomes but did result in earlier recovery of function, which may be advantageous to patients and can help explain the increased use of internal fixation 73,80 . In addition to the initial injury, secondary functional deficiencies can occur due to swelling, nerve compression, and patient avoidance to use the hand.…”

Distal radius kırıklarının cerrahi tedavisi

“…Ancak, erken dönemde serbest hareket gerektiren hastalarda plak tespiti daha avantajlı-dır. [24,25] İnstabil eklem dışı kırık tespitinde, sabit açılı intramedüller distal radius çivileri ile karşılaştırıldığın-da, volar plak tespiti ile arasında uzun dönemde fark bulunamamıştır. [26] geliştirilen ve geniş klinik uygulama alanı bulan sabit ya da değişken açılı kilitli plak teknolojisi ile volar, dorsal, kombine ve parçaya özgü yaklaşımlarla, osteopenik kı-rıklarda bile başarılı sonuçlar bildirilmektedir.…”