Functional Outcome of Unstable Distal Radius Fractures - Treated by Percutaneous K - Wire Fixation

Abstract

BACKGROUND: Distal radius fractures are very common and increasing in incidence, especially in older age group. There are various methods of treatment available each one has its own merits and demerits. Our technique involves closed reduction, percutaneous K-wire fixation, and POP immobilzation of the unstable distal radius fracture for 4-6 weeks. This study aims to examine the functional outcome of percutaneous pinning of these unstable distal radius fractures. MATERIAL AND METHODS: This is a prospective study of 48 patients aged between 35years to 74years, with unstable distal radius fracture. Patients were treated by closed reduction, percutaneous pinning using two to three k-wires. The wires are cut and bent to the outside. A posterior below elbow POP slab was applied for 4-6 weeks. All the patients were fallowed up at regular intervals of 3weeks, 6 weeks, 12 weeks and 24 weeks. The functional evaluation was done at 24 weeks follow-up. We used Sarmiento's modification of Lindstrom criteria and Gartland & Warley's criteria for evaluation of results. RESULTS: Excellent to good results were seen in 91.66% of cases, fair results in 8.34%. CONCLUSION: Percutaneous pinning is a simple, functionally effective, safe method to maintain the fracture reduction and prevent stiffness of wrist and hand. KEYWORDS: Distal Radius Fractures, K-Wire Fixation. INTRODUCTION:The management of Distal Radius Fracture has changed significantly since Colle's proclamation 1814. Fractures of the distal radius constitute 20 % of all the fracture cases treated in the Emergency Orthopaedics department. (1) It is second to the hip fracture in old people. There are various methods evolved, over the period of many years.The early method of closed reduction and cast immobilization has resulted in malunion, joint stiffness and deformity. It adversely affects the wrist and hand function by interfering with the mechanical advantage of the extrinsic hand musculature. (2,3,4) Closed reduction and POP immobilization often leads to collapse of the radius and subluxation of distal radio-ulnar joint. (5) Percutaneous pinning provides additional stability and is one of the earliest methods of fixation. Depalma described ulno-radial pinning at 45º angle. (6) Stein advocates an additional dorsal 2mm kwire with radio-ulnar pinning. (7) Kapandji described double Intrafocal pinning into the fracture surface using 2mm k-wires. (8) and Raycheck recommended ulno-radial pinning along with the fixation of the distal radio-ulnar joint. (9) Spanning external fixation and ligamentotaxis indirectly reduce the impacted articular fragments and directly neutralizes the axial load in the radius. (10) Rush etal, Schumr, and many others described open reduction and internal fixation of the distal radius unstable intraarticular fractures. (11) Doi atal described arthroscopic guided fracture reduction. (12)