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High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures

Published in Chirurgie de la main. 2008, vol. 27, no. 4, p. 160-6
Abstract Kirschner wire (K-wire) fixation is a common technique aimed at treating unstable distal radius fractures. We report our experience with extrafocal K-wire fixation in the treatment of unstable distal radius fractures in 34 patients (AO classification: 10 A2, 5 A3, 14 C1, and 5 C2). The patients' median age was 63 years (range, 16-87 years). K-wires remained in place for a median duration period of 42 days, and a splint was applied during 44 days in median. The median follow-up was 2.5 years (range, 1.3-5 years). At the final follow-up examination, all patients were assessed clinically and bilateral radiographs were taken. The median final range of motion was 69 degrees /64 degrees for extension/flexion, 88 degrees/82 degrees for pronation/supination and 36 degrees/21 degrees for ulnar/radial deviation. Grip strength was 81% of the contralateral side. Using the Gartland-Werley score, 12 patients (35%) had excellent results, 17 (50%) good, and five patients (15%) had fair results. The median final radiographic dorsal tilt was 4.5 degrees (range, 0-14 degrees) and 79% of patients had a loss of volar reduction (median 8 degrees). Radial inclination was in median 20 degrees (range, 10-32 degrees) with 82% of the patients with loss of reduction (median 5 degrees). Radial shortening was in median 0.9 mm (range, -2 to +5 mm) and 62% of patients had median loss of radial length of 1.1mm. Radial shortening was the major source of pain due to ulnar impingement. We found a high complication rate, with 15 patients (44%) suffering from at least one of the 30 reported complications. We did not find any direct correlation between radiographic results and mobility. Although good clinical outcome may be obtained, K-wire fixation cannot be routinely recommended.
Keywords AdolescentAdultAgedAged, 80 and overBone Wires/adverse effectsFemaleFollow-Up StudiesFracture Fixation, Internal/adverse effects/instrumentationHand StrengthHumansJoint Instability/surgeryMaleMiddle AgedRadius Fractures/radiography/surgeryRange of Motion, ArticularWrist Joint/radiography/surgery
PMID: 18678519
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Research group Chirurgie orthopédique et traumatologique (98)
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VAN AAKEN, Jan et al. High rate of complications associated with extrafocal kirschner wire pinning for distal radius fractures. In: Chirurgie de la main, 2008, vol. 27, n° 4, p. 160-6. doi: 10.1016/j.main.2008.05.005 https://archive-ouverte.unige.ch/unige:34492

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Deposited on : 2014-02-26

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