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

Jaypee Brothers Medical Publishing - Tập 8 - Trang 89-95 - 2013
Mohamed F. Mostafa1
1Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Tóm tắt

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.

Tài liệu tham khảo

Owen RA, Melton LTIII, Johnson KA, Ilstrup DM, Riggs BL (1982) Incidence of Colles’ fracture in a North America community. Am J Public Health 72:605–607 Jupiter JB (1991) Current concepts review. Fractures of the distal end of the radius. J Bone Joint Surg [Am] 73:461–469 Simic PM, Weiland AJ (2003) Fractures of the distal aspect of the radius: changes in treatment over the past two decades. Instr Course Lect 52:185–195 Colles A (1814) On the fracture of the carpal extremity of the radius. Edinb Med Surg J 10:182–186 McQeen M, Caspers J (1988) Colles’ fracture: does the anatomical result affect the final function? J Bone Joint Surg [Br] 70:649–651 Aro HT, Koivunent T (1991) Minor axial shortening of the radius affects outcome of Colles’ fracture treatment. J Hand Surg [Am] 16:392–398 Adams BD (1993) Effects of radial deformity or distal radioulnar joint mechanics. J Hand Surg [Am] 18:492–498 Fujj K, Henmi T, Kanematsu Y et al (2002) Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong) 10:9–15 Clancey GJ (1984) Percutaneous Kirschner-wire fixation of Colles’ fractures. J Bone Joint Surg [Am] 66:1088–1114 Kurup HV, Mandalla V, Shaju A, Beaumont A (2007) Bicortical K-wires for distal radius fractures: how many? Acta Orthop Belg 73:26–30 Crenshaw AH Jr (1982) Fractures of the shoulder, girdle, arm and forearm. In: Crenshaw AH (ed) Campbell’s operative orthopedic, 4th edn. Mosby, St. Louis Kapandji A (1987) Intra-focal pinning of fractures of the distal end of the radius 10 years later. Ann Chir Main 6:57–63 Hargreaves DG, Drew SJ, Eckersley R (2004) Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. J Hand Surg [Br] 29:374–376 Singh S, Trikha P, Twyman R (2005) Superficial radial nerve damage due to Kirschner wiring of the radius. Injury 36:330–332 Van Aaken J, Beaulieu JY, Della Santa D, Kibbel O, Fusetti C (2008) High rate of complications associated with extrafocal Kirschner wire pinning for distal radial fractures. Chir Main 27(4):160–166 Chia B, Catalano LW 3rd, Glickel SZ, Barron OA, Meier K (2009) Percutaneous pinning of distal radius fractures: an anatomic study demonstrating the proximity of K-wires to structures at risk. J Hand Surg [Am] 34(6):1014–1020 Sato O, Aoki M, Kawaguchi S, Ishii S, Kondo M (2002) Antegrade intramedullary K-wire fixation for distal radial fractures. J Hand Surg [Am] 27(4):707–713 Lafontaine M, Hardy D, Dellince PH (1989) Stability assessment of distal radius fractures. Injury 20:208–210 Frykman G (1967) Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand Suppl 108 Kreder HJ, Hanel DP, Mckee M, Jupiter J, Mc Gillivary G, Swiontkowski MF (1996) Consistency of AO fractures classification for the distal radius. J Bone Joint Surg [Br] 78:726–730 Green DP, O’Brien ET (1978) Open reduction of carpal dislocation. Indications and operative techniques. J Hand Surg 3:250–265 Cooney WP, Dobyns JH, Linscheid RL (1980) Complications of Colles’ fractures. J Bone Joint Surg [Am] 62:613–619 Stewart HD, Innes AR, Burke FD (1985) Factors affecting the outcome of Colles’ fracture: an anatomical and functional study. Injury 16:289–295 Miyake T, Hashizume H, Inone H et al (1994) Malunited Colles’ fracture. Analysis of stress distribution. J Bone Joint Surg [Br] 19:737–742 Hutchinson DT, Strenz GO, Cautilli RA (1995) Pins and plaster vs external fixation in the treatment of unstable distal radial fractures randomized prospective study. J Hand Surg [Br] 20:365–372 Lenoble E, Dumontier C, Goutallier D, Apoil A (1995) Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations. J Bone Joint Surg [Br] 77:562–567 McBirnie J, Court-Brown CM, McQueen MM (1995) Early open reduction and bone grafting for unstable fractures of the distal radius. J Bone Joint Surg [Br] 77:571–575 Hochwald NL, Levine R, Tornetta PIII (1997) The risks of Kirschner wire placement in the distal radius: a comparison of techniques. J Hand Surg [Am] 22:580–584 Melone CP Jr (1984) Articular fractures of the distal radius. Orthop Clin North [Am] 15:217–236 Rosati M, Bertagnini S, Digrandi G, Sala C (2006) Percutaneous pinning for fractures of the distal radius. Acta Orthop Belg 72:138–146 Trumble TE, Schmitt SR, Vedder NB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg [Am] 19:325–340