DO KIRSCHNER WIRES MAINTAIN REDUCTION OF DISPLACED COLLES’ FRACTURES?

Abstract

Introduction: Displaced Colles’ fractures are usually managed by closed reduction and cast immobilisation. They are reduced initially but frequently lose position because cast immobilisation is an inefficient means of stabilisation. This results in malunion. If position is lost after reduction and cast immobilisation or the fracture is unstable, closed reduction and cast immobilisation is often supplemented by longitudinal k-wire fixation. There is a paucity of literature examining the incidence of unacceptable malunion after closed reduction and k-wire stabilisation.

Aim: The aim of this study was to determine whether closed reduction, longitudinal k-wire fixation and cast immobilisation of displaced fractures of the distal radius avoids unacceptable malunion. A secondary aim was to define the type of fracture best treated by this method.

Methods: 53 patients underwent closed reduction and longitudinal k-wiring of displaced Colles’ fractures and were reviewed after a mean of 26 months. Radiographs taken at the time of injury, after reduction and k-wiring, and at fracture union were compared for radial shortening and dorsal angulation.

Results: Manipulation significantly improved fracture position (p< 0.001). Dorsal angulation was successfully corrected by manipulation in 98%, and this position was maintained to fracture union in all cases. 73% of fractures manipulated for radial shortening > 2mm were adequately reduced, but 41% of these fractures subsequently lost position to malunite. The mean shortening between reduction and fracture union was 1.6mm. This did not correlate with Frykman Class or radial shortening at injury.

Discussion: Closed Reduction and k-wire stabilisation is an attractive technique because it is relatively non-invasive compared with plating or external fixation. However, a degree of radial shortening between reduction and fracture union must be anticipated. Fractures not reduced to allow for this later loss of radial length are more likely to malunite. This may compromise functional outcome.