A MODIFICATION OF THE “KAPANDJI METHOD” FOR THE REDUCTION AND FIXATION OF DISTAL RADIUS INTRA AND EXTRA ARTICULAR FRACTURES

Abstract

Background: Fractures of the distal radius are among the most common fractures encountered.

In the US these fractures account for 20% of all fractures treated at emergency care units. Methods for fixation of distal radius fractures include: casting, external fixation devices, plating, and percutaneus pinning.

In the prospective, randomized study by Strohm et al., the results of conventional Kirschner wire osteosyn-thesis were compared with those of a modified Kapandji method (“intrafocal pinning”). The functional and radiographic results of the Kapandji method were superior to those of the other technique.

We utilized a modification of the Kapandji method on a broad spectrum of distal radius fractures, including intra-articular fractures. The primary results and current follow up are presented.

Materials and Methods: 14 patients were treated. Fractures were classified according to Frykman’s classification system, ranging from Frykman’s 1 to 8. The inclusion criteria were all distal radius fractures, which had failed an initial closed reduction. Reduction was accomplished by inserting Kirschner wires percutaneusly through the fracture (intrafocal pinning) and utilizing them as levers to reduce the fragments. The wires were then advanced to be anchored in the proximal cortex. Additional wires were inserted after reduction, through the distal and proximal fragments. The forearm was fixed in a short cast for six weeks after which the Kirschner wires were removed and wrist motion exercise begun. Results were judged according to:

1. Roentgenographic appearance (early post op, and at follow up) according to the text book reduction criteria.

2. Clinical assessment of the operated wrist at fallow up

3. Subjective patient feeling.

Results: Follow-up duration was 3–19 month. Reduction was graded “good” in 11 cases and “fair” in the remaining 3. All fractures united. Time to union was 4–9 weeks. Fracture reduction was maintained until union, in all cases. None of the patients needed an additional surgical corrective procedure. Functional results were satisfactory (with the limitations of too short follow-up in some of the cases). There were no cases of infection at pin site, deep or superficial.

Conclusions: The modified Kapandji method for percutaneus pinning of distal radius fractures is a useful tool for reduction and fixation of almost any sub-type of distal radius fractures, including intraarticular displaced fractures.

This technique has become our first choice of treatment, when closed reduction and cast fixation had failed to achieve or maintain reduction.