The outcomes of displaced paediatric distal radius fractures treated with percutaneous Kirschner wire fixation: a review of 248 cases

Abstract

This study aimed to evaluate the effect of manipulation under anaesthesia (MUA) and Kirschner wire (K-wire) fixation of displaced, paediatric distal radius fractures on residual radiological angulation, displacement, and shortening, as well as functional outcomes, including complication rates. A retrospective review was conducted of all paediatric patients undergoing MUA and K-wire fixation for an extra-articular distal radius fracture over a period of 5 years. A total of 248 patients were included in the study with a mean age of 9.9 years (3-15). Mean follow-up was 6.6 weeks (4-156). There was a statistically significant increase in median dorsal angulation (p<0.0001) between initial post-operative and follow-up radiographs at the time of K-wire removal. The number of K-wires used did not have a significant effect on dorsal angulation (p=0.9015) at time of K-wire removal, nor did the use of an above or below elbow cast (p=0.3883). Seventeen patients required a further general anaesthetic (5 revision operations, 12 removal of migrated K-wires). Eighty-seven percentage of (215 patients) of patients had normal function at follow-up post-K-wire removal. Angulation at time of K-wire removal of more than 15° was significantly associated with reduced functional outcome (p=0.0377). A total of 41 patients (17%) had complications associated with K-wire use. We conclude that though K-wire fixation is an effective technique, it does not prevent re-angulation of the fracture and is associated with a significant complication rate. Given the remodelling potential and tolerance to deformity in children, surgeons should give careful thought before utilising this technique for all displaced or angulated paediatric distal radius fractures. If used, 1 K-wire with immobilisation in a below elbow cast is sufficient in most cases.

Plate Fixation for Unstable Displaced Distal Radius Fractures in Children

“…21 In contrast to the high complication rate of 16 to 38% for kwire fixation (superficial infection, skin irritation, and migration of wires), only two complications of temporary stiffness (n ¼ 2; 8%) were found in our cohort following volar plate fixation. 8,11 Since volar plate fixation of pediatric distal radius fractures is rare, no appropriate plate is available. Therefore, we noticed variable adjustments of plates to get these to match the radius.…”

Is percutaneous pinning needed for the treatment of displaced distal radius metaphyseal fractures in children?

“…[ 32 ] In contrast, in the pinning group, the main complications included loss of reduction, prominent scar, infection, pin migration, tendon irritation, re-fractures, transient neuropraxia, and failed insertion. [ 33 , 34 ] Of the 4 studies that reported complications, [ 17 – 20 ] only 1 included re-displacement. [ 18 ] In our review, we included the re-displacement into the complications in all the trials.…”

Treatment of distal radius metaphyseal fractures in children: a case report and literature review

“…They concluded that clinicians should be careful before considering the use of K-wires after manipulation of distal radius fractures in children. 6 Another case report highlighted the risk of developing a Brodie's abscess of the distal radius five-and-a-half years later as a result of initial K-wire fixation. 42 This case highlights the patient in Figure 1A and 1B in which a 7-year-old developed chronic osteomyelitis of the distal radius following manipulation and K-wiring.…”

“…2 Complications of this fracture and its treatment include acute compartment syndrome, carpal tunnel syndrome, necrotising fasciitis, nerve injuries, osteomyelitis and malunion. [3][4][5][6] The purpose of this study is to highlight important factors related to treatment decisions of distal radius fractures in children and to make recommendations based on the literature reviewed. These areas will include: 1) the remodelling potential of distal radius metaphyseal fractures; 2) factors associated with redisplacement of these fractures; 3) indications for using a K-wire in paediatric distal radius metaphyseal fractures; and 4) potential complications of treatment using K-wires in these fractures ( Figure 1) will be highlighted by means of a case report.…”