Percutaneous K-wires vs palmar locking plate fixation for different types of distal radial fractures: a comparison of the outcomes of two methods to controll our guidelines

Abstract

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation. Patients and Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures. Results: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group. Conclusion: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.

The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial

“…14 Zyluk et al observed volar tilt angles closer to normal ones in a group with volar plate fixation and K-wire stabilization. 19 The mean post-treatment volar tilt angles reported by Zengin et al were within the adopted normal range in patients treated with volar plate fixation (6.9°) but fell outside of the normal range (−1°) in patients treated with cast immobilization. 15 In our study, volar tilt values closer to normal were observed in the 6-week group, whereas values different from the normal ones were noticed in the 4-week group.…”

“…The volar tilt angle values in our study were similar to those of other studies. 7,9,[13][14][15]19 The mean radial height value in DRF patients treated with cast fixation was 3.9-9.0 mm, depending on the group. 9,[13][14][15] In our study, both groups achieved radial height values close to normal.…”

“…Some studies have reported a correlation between good radiological and clinical outcomes. 5,19,20 A long period of immobilization in a cast may adversely affect the range of motion and hand function, and reduce muscle strength in patients with DRF. 16,17,21,22 These factors suggest the need for limiting the period of immobilization in elderly patients with DRFs.…”

Treatment of Distal Radius Fractures Using a Cemented K-Wire Frame

“…Moreover, oblique Kapandji K-wires engaging a single cortical wall risk wire migration, especially in oblique and comminuted fractures. Its stability depends on the correct wire position, a good fracture pattern, intact cortical wall, and good bone quality, but these factors may be compromised due to the lack of direct visualization of the tissue and fracture site 10 . These drawbacks prompted us to modify the xation technique.…”

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

“…In addition, oblique Kapandji K-wires engaging a single cortical wall risk wire migration, especially in oblique and comminuted fractures. The stability depends on proper wire placement, fracture patterns, intact cortical walls, and good bone quality, but these factors may be affected by the inability to visualize the soft tissues and fracture site [ 10 ]. Those drawbacks prompted us to modify the fixation technique.…”