The aim of this study was to find out whether distal radius fractures treated by K wire fixation loose reduction after wire removal and analyze the variables may influence this. Patients who underwent K wire fixation for unstable fractures of distal radius over a period of 3 years were included in this retrospective study. Fractures were classified according to AO classification. Radiographs taken just prior to removal of K wires and radiographs taken at least 1 month after wire removal were analyzed to study three radiological parameters; Palmar or dorsal tilt, radial inclination and ulnar variance. Loss of these angles was analyzed statistically against variables like age, sex, AO classification, type of K wires used, delay in fixation and duration of fixation. 59 fractures were analyzed with mean age of 56 years and male to female ratio of 1:2. Average loss of radial tilt was 2.6 deg, loss of palmar tilt was 2.6 deg and loss of ulnar variance was 1.3 mm. We found that distal radius fractures treated by percutaneous K wire fixation, do not suffer significant loss of reduction of fracture position after removal of wires. This remains true regardless of age, sex, fracture type according to AO type, type of wires used, delay in fixation or duration of wire fixation.

Aim: To identify the variables associated with poor radiological outcome in the distal radius fractures stabilized with K wires.

Materials & Methods: All the patients who underwent K wire fixation of distal radius fracture in last 3 years were included in this retrospective study. AO Classification was used to classify the fracture. Immediate post fixation radiographs and radiographs taken just prior to removal of K wires (5–6 weeks) were analyzed to study three radiological parameters (dorsal tilt, radial tilt, ulnar variance). Changes in these parameters were recorded. Results were graded as excellent, good, fair and poor according to the Stewart classification. The results were analyzed against variables like age, sex, AO classification, associated ulnar fracture, number of k wires used, delay in fixation and duration of fixation. Statistical tests were performed to find out variables associated with the poor radiological outcome.

Results: 113 distal radius fractures were analyzed in total. Average age of patients was 56.2 years (standard deviation-19.9) with male to female ratio of 1:2.1. Average loss of radial tilt was 4.12 deg, loss of dorsal tilt was 8.07 deg and change in the ulnar variance was 3.12 mm. We found excellent results in 23.9 %, good result in 56.6%, fair results in 15 % and poor results in 4.4 % of patients.

Age more than 65 years (p value 0.006), comminuted distal radius fracture [A3 or C3 in AO classification] (p value 0.049) and associated ulnar fracture (p value 0.013) were the variables found to have statistically significant correlation with poor radiological outcome.

Conclusion: Age more than 65, comminuted distal radius fracture and associated ulnar fracture are the variables associated with poor stability of K wire fixation in distal radius fracture. Alternative mode of stabilization should be considered to improve the stability of the fracture fixation in these patients.

The infection in total joint arthroplasty in most cases is blood borne in origin, but seeding of organisms at the time of surgery is also a well recognised cause. The aim of our study was to determine the optimal timing to administer the prophylactic per-operative antibiotics in total knee arthroplasties performed under tourniquet control.

The patients were randomised in two groups “A” (18 patients), received antibiotics at the time of induction of anaesthesia and group “B” (15 patients), received antibiotics ten minutes prior to the release of tourniquet. We used the intravenous doses of Kafadol 1gm and Gentamicin 160mgs for 24 hours. The antibiotic levels were assessed using blood samples taken from the peripheral vein, operative wound (periprosthetic area) and suction drains. Both groups were well matched with regard to age, weight, sex, ASA class and number of patients.

In group “A” the antibiotic levels were lower in operative wound as compared to the peripheral vein and it continued to decline in the post operative period. In group “B” the levels were 40% higher in the samples from the operative wound and remained significantly high in post operative period, as compared to those in group “A”.

Our findings are in favour of antibiotic administration just before the release of the tourniquet in the total knee arthroplasty.