Abstract
Percutaneous wiring is a successful technique for the management of distal radial fractures. Practice differs according to surgeon preference as to whether the wires used are buried or protruding. To assess patient satisfaction with wither technique, we prospectively randomised 52 consecutive patients undergoing percutaneous wiring for distal radius fractures with regard to whether the wires were buried or not.
Patients with a distal radial fracture managed with percutaneous wire fixation and casting only were randomly allocated to have the wires buried or protruding. The fractures were classified according to Frykmn’s classification of fractures of the distal radius, and there were no differences between the groups (p=0.9).
The total number of patients studied was 52, with a mean age of 56.6 years (range 19–84). The female: male ratio was 38:13. Twenty-five (48%) patients had percutaneous wiring of their fracture with the Kirschner wires buried and 27 (52%) had the wires protruding. Cast and wire fixation were removed at a mean duration of 5.8 weeks in an outpatient setting. Patients recorded whether they experienced pain during the period of wire fixation or pain during the removal of wires on a visual analogue scale. Fifteen patients reported pain during the period of fixation (55.5%), the severity ranged between 2–8 (mean 3.8) with no significant difference between the groups (p=0.8). All patients with buried wires compared with 10% of those protruding wires required local anaesthesia in the operating theatre for removal (p=0.03). Superficial infection was diagnosed in 4 patients with no significant difference between groups (p=0.14).
Buried wires are typically advocated to prevent pin site infections and to improve patient comfort and satisfaction. However, we found no difference between the study groups with regard to patient satisfaction, pain during the period of fixation or pin-site infections. Furthermore, all patients in the buried wire group required local anaesthesia for removal with some of these necessitating a visit to the operating theatre. We therefore feel that burying these wires confers no advantage while adding to the complexity, time and cost of removal and recommend leaving wires protruding through the skin.
The abstracts were prepared by Raymond Moran. Correspondence should be addressed to him at the Irish Orthopaedic Assocation, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
