Radiological outcomes of distal radius extra-articular fragility fractures treated with extra-focal kirschner wires

• Published in: Injury Vol. 41; no. 6; pp. 639 - 642
• Main Authors: Kennedy, C, Kennedy, M.T, Niall, D, Devitt, A
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-06-2010; Elsevier
• Subjects: Aged; Biological and medical sciences; Bone Wires; Casts, Surgical; Colles' Fracture - diagnostic imaging; Colles' Fracture - surgery; Diseases of the osteoarticular system; Distal radius fractures; Extra-focal percutaneous pinning; Female; Fracture Fixation - methods; Humans; Injuries of the limb. Injuries of the spine; Joint Instability - diagnostic imaging; Joint Instability - surgery; Medical sciences; Middle Aged; Orthopedics; Radial shortening; Radiography; Radius - diagnostic imaging; Traumas. Diseases due to physical agents; Treatment Outcome; Ulna - diagnostic imaging; Ulnar variance; Distal radius fractures; Extra-focal percutaneous pinning; Ulnar variance; Radial shortening; Radius; Pathologic fracture; Prognosis; Diseases of the osteoarticular system; Shortening; Wire; Percutaneous route; Treatment; Orthopedics; Bone; Anchoring
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2010.02.003

Abstract Introduction The classical colles fracture (extra-articular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture. Methods We retrospectively analysed 72 consecutive cases of colles fractures treated with inter-fragmentary k-wire fixation, in female patients over 60 years of age, in two orthopaedic centres, under the care of 12 different orthopaedic surgeons. We correlated the radiographical distal radius measurements (ulnar variance, volar tilt, and radial inclination) at the pre-operative and intra-operative stages with the final radiographical outcome. Result Mean dorsal angulation was 21° at time of presentation. Closed reduction significantly improved fracture position to a mean of 2.7° volar angulation ( p < 0.05). Mean angulation at time of k-wire removal was 1.6° dorsal, this was not significant in comparison to post-reduction measurements ( p < 0.05). Mean ulnar variance at time of presentation was 2.5 mm (range 7.4 to −4.2). Reduction improved fracture displacement to a mean of 0 mm, which was statistically significant ( p < 0.05). Mean ulnar variance at time of k-wire removal was 2.4 mm ( p < 0.05). 56.8% of cases demonstrated radial shortening of 2 mm or more. Conclusion In female patients over 60 years of age, the best predictor of radial length, when k-wire fixation is to be used, is the radial length prior to fracture reduction. Thus if there is radial shortening visible in the initial radiographs as measured in terms of ulnar variance, one should consider a method of fixation other than inter-fragmentary k-wires.