DISTAL RADIUS FRACTURE – AN AUDIT OF THE EFFICACY OF PERCUTANEOUS K WIRING

Abstract

To assess the efficacy of percutaneous K wiring in the treatment of distal radius fractures.

A retrospective audit was performed of patients with distal radius fractures treated with the combination of manipulation under anaesthetic, K wiring and cast application at Auckland Hospital. Patients were identified by using the Orthopaedic Trauma Database. Charts were reviewed for patient demographics, preoperative delay and complications. X-rays were reviewed recording Frykman Grade and radial tilt, radial inclination and ulnar variance preoperatively, immediately postoperatively and at 6 weeks postoperatively.

Seventy five consecutive cases were identified over an 18 month period between May 2002 and October 2003 with 4 excluded because of inadequate notes or x-rays. The majority of patients were female with an average age of 55 years. Most operations were performed by Advanced Trainees using 3 wires with at least one trans styloid wire. 55% of fractures were intra articular. Radial tilt was restored to within 10 degrees of normal in all but 3 patients immediately postoperatively but at 6 weeks 12 patients had more than 10 degrees dorsal tilt. All patients had less than 2mm positive ulnar variance immediately postoperatively but at 6 weeks postoperatively 11 patients had more than 2mm positive ulnar variance. 9 patients (13%) experienced local complications related to the wires.

Manipulation under anaesthetic, K wiring and cast application offers a useful treatment option for distal radius fractures which are reducible but unstable. Care is required with patient selection and surgical technique to minimise complications.