Kirschner Wire Fixation in Dorsally Displaced Distal Radius Fractures: A Biomechanical Evaluation

Abstract

Background There is currently no consensus for the optimum configuration and number of Kirschner wires (K-wires) to use for the stabilization of dorsally displaced distal radius fractures. In this biomechanical study, we compared the load to failure and stiffness of four common K-wire configurations to identify the strongest construct for use in extra-articular dorsally displaced distal radius fractures. Case Description We created a standard distal radius fracture model in turkey tarsometatarsi which was stabilized using two or three K-wires (1.6 mm) in four different configurations. Following a power calculation, 10 fracture models of each configuration underwent testing in cantilever bending and axial compression. Literature Review Recent randomized trials have shown no evidence that volar locking plates are superior to K-wires for the treatment of dorsally displaced distal radius fractures. This has led to an increase in the popularity of much cheaper K-wires. Several different K-wire techniques have been described but there is no strong evidence to determine which is the optimal configuration and number of wires. Clinical Relevance The three-wire interfragmentary configuration was stiffer than the three-wire Kapandji in axial compression and cantilever bending. There was no difference in load to failure in cantilever bending or axial compression. The three-wire interfragmentary technique is the stiffest configuration of K-wires for dorsally displaced distal radius fractures. The two-wire Kapandji technique was significantly weaker than the other configurations, especially in cantilever bending. Conclusion The authors recommend to always use three wires for percutaneous pinning and never to use two intrafocal wires alone.

Treatment of distal radius fractures using a cemented K-wire frame

“…More K-wires can be added between the1 and 2 compartments, 2 and 3 compartments, and 4 and 5 compartments. However, identifying the proper insertion sites and achieving optimal wire placement are difficult [ 6 ]. Moreover, oblique and cross pinning can effectively stabilize transverse fractures because stability depends on the intact of the proximal fragment [ 30 ].…”

“…Percutaneous pinning can help reduce and stabilize the fragments in a minimally invasive manner, especially in DRFs near the wrist (AO types A2 and A3) and some AO type C fractures. Ideally, the Kapandji wiring technique provides high reactive torque to reduce and maintain reduction by passing K-wires through the anatomical windows [ 6 ]. However, optimal wire placement may be difficult to achieve due to tendons, fracture patterns, damaged cortical wall, and anatomical variations [ 7 ].…”