Treatment of Unstable Extra-Articular Distal Radius Fractures by Modified Intrafocal Kapandji Method

Abstract

The authors prospectively assess the results of surgically treated, unstable extra-articular distal radius fractures from 29 patients with good bone quality. Mean age was 49 years, ranging from 22 to 69 years; the female gender was the most frequently affected (58.6% of the cases). Surgical fixation was indicated for fractures presenting an angulation above 20 degrees , marked dorsal comminution, and radius shortening in excess of 10 mm on initial x-rays (anteroposterior and lateral views). The Kapandji technique, with intrafocal, nonthreaded Kirschner wires, was employed. Clinical data assessed anatomic aspects according to Scheck, functional aspect after Gartland and Werley, strength by Scheck's methods, and esthetic by Frykman's criteria. Functional assessment, according to Gartland and Werley, revealed 72.1% of excellent and good results at 3 months; 89.7% at 6 months; and 96.6% at 12 months. Immediate postoperative reduction was not maintained at the final follow-up at 12 months; however, that loss was not severe, and the anatomic outcome was good and excellent in 96.6% of the cases. Six patients presented complications. Four patients presented reflex sympathetic dystrophy; 1 patient had a superficial Kirschner wire infection, and another patient had radial nerve superficial branch paresthesia. The employed technique showed to be effective in the treatment of unstable, extra-articular fractures of the distal radius. It is easy to learn and to perform. The device employed has a low cost and is widely available in operation rooms.

Distal Radius Fractures: Nonoperative and Percutaneous Pinning Treatment Options

“…Ebraheim and colleagues [87] similarly demonstrated excellent or good results in 80% of their over-65 patients and 86% of their under-65 patients, using an intra-focal technique with trans-styloid pin augmentation. In a younger population, Ruschel and Albertoni [78] observed a mild loss of reduction with 95% excellent and good functional results at the 1-year mark with a modified Kapandji technique. Using intrafocal intramedullary K-wires, Walton and colleagues [79] demonstrated 95% excellent or good outcomes using radiographic and functional outcome scoring systems.…”

“…Fritz and colleagues [77] subsequently modified this technique with the addition of a styloid pin. Ruschel and Albertoni's [78] modification of Kapandji's technique added a lateral intrafocal pin for restoration of radial inclination and shift. Walton and colleagues [79] describe a different modification of Kapandji's original technique using intrafocal, intramedullary K-wires.…”

“…The authors' preferred technique is similar to the modified Kapandji technique described by Ruschel and Albertoni [78]. After a closed reduction, two intrafocal dorsal K-wires are placed and manipulated to effect a reduction.…”

Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?

“…[9] Many pinning variations have been described in the literature. [10,11,12,13] However, cross-pin fixation is advocated the most effective method for excellent stability of all major fragments. [14] There is scarce evidence as to the most appropriate number and placement of K-wires and supporting techniques.…”

Percutaneous Pinning of Distal Radius Fractures Using Hematoma Block: Outcomes in Our Center

“…The team used Gartland and Werley score to appreciate the functional results. Patients more than 55 years old or having impaction of the cortices more than 50% of the metaphyseal diameter should benefit from Kapandji-pinning treatment associated with cast immobilization [11], the non-adjunction of plaster cast in 5 patients treated with Kapandji technique may therefore explain the occurrence of mild secondary displacement in the Kapandji group. Carpal condyle thrust progressively leads to radial epiphysis impaction and secondary displacement [12], in our series, 18 secondary displacements were observed at 1 month of which 72% were treated with plaster cast.…”