Percutaneous Pinning of Distal Radius Fractures: An Anatomic Study Demonstrating the Proximity of K-Wires to Structures at Risk

Chia, Benjamin; Catalano, Louis W.; Glickel, Steven Z.; Barron, O. Alton; Meier, Kristen M.

doi:10.1016/j.jhsa.2009.04.004

Cited by 35 publications

(30 citation statements)

References 17 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Percutaneous pinning such as trans-styloid and Kapandji procedure is a simple and cost-effective technique provided that the distal radius is not severely comminuted or osteoporotic [3]. Because the pin is inserted close to the wrist joint, complications such as skin irritation, sensory nerve injury, tendon rupture and RSD are common [13–16]. To avoid these complications and to stabilize distal radial fractures, antegrade intra-medullary K-wire fixation was performed.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde Kirschner-wire (K-wire) fixation can be extrafocal-bicortical [9, 11] or intra-focal-unicortical [12]. Many complications have been reported after retrograde pinning for distal radial fractures, including soft tissue irritation, injury to radial sensory nerve and extensor tendons, pain, algodystrophy, pin tract infection especially when left outside the skin and loss of reduction [13–16]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires

Mostafa

2013

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

The treatment of unstable Colles-type distal radial fractures remains a challenge. A prospective study was conducted to evaluate the outcomes of the treatment of unstable distal radial fractures using antegrade intra-medullary K-wires. Twenty-eight Colles-type distal radial fractures were selected excluding comminuted intra-articular and Barton’s fractures. The blunt tips of intra-medullary K-wires were introduced in an antegrade direction to support the subchondral bone of the distal fragment. The scoring system of Green and O’Brien modified by Cooney et al. was used for the final clinical evaluation. The radiological outcomes were evaluated using the scale proposed by Stewart et al. After a mean follow-up of 34 months (range 14–46), 17 patients were rated clinically excellent, seven good, three fair and one poor. The mean loss of radial height, radial inclination, volar tilt and ulnar variance was 0.9 mm, 1.9°, 0.5° and 0.4 mm, respectively. These results were comparable with the values reported in other pinning studies. Only one patient complained of skin irritation and painful bursitis in the forearm; otherwise, no complications related to tendon or nerve injury were encountered. One patient had protrusion of K-wire into the wrist joint. The technique proved to be effective in maintaining reduction in distal radial fracture with low rate of soft tissue complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires

Mostafa

2013

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

show abstract

“…Pinning the dorso‐radial area is highly risky with regard to tendon complications, with a prevalence rate of approximately 30%, but less risky to the nerves (3.4%). Only the results reported by Chia et al () differentiated between touching and piercing of a tendon by a K‐wire. However, in the remaining studies, tendon involvement was described as an injury.…”

Section: Discussionmentioning

confidence: 99%

Tendon and neurovascular injuries of the distal radius after pinning with Kirschner Wires: A meta‐analysis of cadaveric studies

2015

View full text Add to dashboard Cite

Tendon and nerve structures are at risk when displaced fractures of the distal radius are pinned using K-wires. The aim of this meta-analysis (MA) is to examine the published evidence of such complications in cadavers. Eight studies met our inclusion criteria. The meta-analytical results were as follows: (a) 2.87% and 30.5% tendon involvement at the radial styloid process (RSP) and the dorso-radial area of the distal radius, respectively; (b) 3.5% and 1.1% tendon involvement when the percutaneous pinning (PP) and the limited open pinning (LOP) techniques were used, respectively; (c) 16.1% and 3.4% nerve involvement at the RSP and the dorso-radial area of the distal radius, respectively; (d) in 35.7% the nerve was speared and in 64.3% it touched the K-wire at the styloid area; (e) 61.3% cephalic vein involvement in the styloid area; (f) the second branch of the sensitive branch of the radial nerve (SBRN) was the closest to a wire inserted into the RSP; (g) the mean (±SD) distance between a branch of the SBRN and a styloid wire was 2.17 ± 0.82 mm. Our results for nerve and tendon injury frequencies in the RSP were close to those in clinical meta-analytical studies, offering an excellent statistical model of evidence synthesis based on cadaveric studies to assess the frequency of such injuries in clinical practice. However, this cadaveric MA yielded more accurate data than the previously reported clinical MA in assessing the real risk of injury of such structures in the distal radius in terms of their proximity to the inserted K-wires.

show abstract

“…As previously described in studies by Chia et al (2009), Kamineni et al (2009), andWang et al (2009), these anatomic principles encompass a wide range of surgical procedures ranging from percutaneous pinning to intramedullary nail placement to compression plating. Injury to the radial nerve proximally frequently manifests in the wrist and hand as loss of dorsal hand sensation and inability to extend the wrist or digits (i.e.…”

Section: Discussionmentioning

confidence: 99%

Predicting radial nerve location using palpable landmarks

et al. 2010

View full text Add to dashboard Cite

The purpose of this study is to predict the location of radial nerve (RN) utilizing palpable anatomic landmarks. Thirty-four paired upper limbs were dissected. The RN was localized: (1) at the humeral spiral groove (SG), (2) lateral intermuscular septum (LIS), and (3) at its' division into the posterior interosseous nerve (PIN) and radial sensory nerve (RSN). The PIN was located at the anterior aspect of the radial neck (AN). Humeral and radial lengths were measured. The RN traversed the SG, on average, 48% (36%-63%) of humeral length, distal to the greater tuberosity. The RN pierced the LIS, on average, 38% (29%-56%) of humeral length, proximal to the lateral epicondyle (LE). The PIN/RSN division occurred on average 1.0 cm (-11.4 to 3.5) distal to the LE. The PIN crossed the AN, on average, 10% (5%-14%) of radial length, distal to the radial head articular surface.

show abstract

Percutaneous Pinning of Distal Radius Fractures: An Anatomic Study Demonstrating the Proximity of K-Wires to Structures at Risk

Cited by 35 publications

References 17 publications

Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires

Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires

Tendon and neurovascular injuries of the distal radius after pinning with Kirschner Wires: A meta‐analysis of cadaveric studies

Predicting radial nerve location using palpable landmarks

Contact Info

Product

Resources

About