Abstract
Introduction: Fractures of the distal radius are amongst the most commonly encountered injuries in orthopaedic trauma. Treatment options include closed manipulation, percutaneous fixing using K wires and external fixation. Restoration of the volar tilt and radial length are proven to have a positive correlation with a good functional outcome.
A randomised prospective study has been performed to compare the effectiveness of percutaneous stabilisation using K wires inserted in the traditional transcortical fashion with K wires inserted using a novel intramedullary spring loaded technique. The treatments were compared for their ability to restore normal anatomy, carpal alignment and function of the hand after unstable fractures of the distal radius.
Patients and Methods: Between October 2001 and February 2002, 46 patients with unstable fractures of the distal radius were entered into the study. There were 37 females and 9 males, mean age of 58 years (range 17–87). Fractures were classified using the AO system. Patients were randomly allocated using closed envelopes into one of two groups. All fractures were reduced, and three 1.6mm K wires were inserted using one of two techniques. Group I (24 pts) had the wires engaged into the opposite cortex and driven down the medullary canal (spring-loaded). All patients were followed up for a minimum of 6 weeks. Radiological and functional evaluation was performed.
Results: Immediate post operative radiographs showed a mean dorsal angle of –3° in Group I (ie 3 degrees volar tilt) and –7.5° in Group II. Restoration of radial length was similar in both groups. By 6 weeks, the mean dorsal angle for Group I was −1.9°, and –10.6° in Group II. The mean loss of radial length was similar in both groups (1.2mm in Group I; 1.3mm in Group II). Functional outcome was assessed using the Wrist Function Score2, and was similar in both groups at 6 weeks. There were 2 early fixation failures, both in Group I, and both class C3 fractures (AO).
Conclusion: ‘Spring loaded’ percutaneous K wiring of distal radius fractures results a significantly superior restoration of volar tilt post operatively and at 6 weeks when compared against the transcortical technique. The ‘spring’ translates into a dynamic force reducing the fracture. We estimate that these radiological results will result in a superior functional outcome in the longer term.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
