Comparison of Percutaneous K-wire and T-plate Fixation in Treatment of Distal Radius Fractures
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Published:
Apr 30, 2015
Keywords:
Distal radius fractures T-plate percutaneous K-wires
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Abstract
Purpose: The most effective method for the surgical treatment of distal radius fractures has not been established. Two commonly used techniques are percutaneous K-wire and T-plate fixation. We performed a retrospective study to compare these two treatment strategies.
Methods: A total of 68 patients were selected for review. Each patient was treated by one of the two methods. Data including operative time, pain scale, radiological result, disabilities of the arm shoulder and hand (DASH) score, and operative complications were collected.
Results: Thirty-six patients were treated with percutaneous K-wire, and the rest (32) were treated with T-plate fixation. The percutaneous K-wire group was associated with significantly shorter operative times and length of hospital stays, and lower postoperative pain (P<0.05), but had more complications (P=0.033). There were no significant differences in DASH scores and radiological results between the two groups.
Conclusion: The percutaneous K-wire technique is similar in effectiveness to the T-plate in the treatment of distal radius fractures with shorter operative times and hospital stays, and lower postoperative pain, but had more complications.
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References
1. Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am 2007; 89: 2051-62.
2. Diass JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilization in the treatment of Colles’ fractures. J Bone Joint Surg Br 1987; 69: 727-9.
3. Keating JF, Court-Brown CM, McQueen MM. Internal fixation of volar-displaced distal radial fractures. J Bone Joint Surg Br 1994; 76: 401-5.
4. Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg 2005; 13: 159-71.
5. Stevenson I, Carnegie CA, Christie EM, Kumar K, Johnstone AJ. Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy. J Trauma 2009; 67: 612-6.
6. Andrew H, Crenshaw JR. Fractures of shoulder arm and forearm. In: Canale S, editor. Campbell's operative orthopaedics. 10th ed. Philadelphia: Mosby; 2003. pp. 3058-66.
7. Green DP. Pins and plaster treatment of comminuted fractures of the distal end of the radius. J Bone Joint Surg Am 1975; 57: 304-10.
8. Weil WM, Trumble TE. Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization. Hand Clin 2005; 21: 317-28.
9. Fu YC, Chien SH, Huang PJ, Chen SK, Tien YC, Lin GT, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma 2006; 60: 330-3.
10. Spira E, Weigl K. The comminuted fracture of the distal end of the radius. Reconstr Surg Traumatol 1968; 11: 128-38.
11. Geller L, Bernstein M, Carli A, Berry G, Reindl R, Harvey E. Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures. Can J Surg 2009; 52: E161-6.
12. Jupiter JB, Marent-Huber M. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. J Bone Joint Surg Am 2009; 91: 55-65.
13. Larson AN, Rizzo M. Locking plate technology and its applications in upper extremity fracture care. Hand Clin 2007; 23: 269-78.
14. Lutsky K, McKeon K, Goldfarb C, Boyer M. Dorsal fixation of intra-articular distal radius fractures using 2.4-mm locking plates. Tech Hand Up Extrem Surg 2009; 13: 187-96.
15. Freeland AE, Luber KT. Biomechanics and biology of plate fixation of distal radius fractures. Hand Clin 2005; 21: 329-39.
16. Anglen J, Kyle RF, Marsh JL, Virkus WW, Watters WC, Keith MW, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg 2009; 17: 465-72.
17. Herron M, Faraj A, Craigen MA. Dorsal plating for displaced intraarticular fractures of the distal radius. Injury 2005; 36: 236.
18. Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking
plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 2011; 36: 974-81.
19. Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M. Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc 2010; 44: 212-9.
20. Hollevoet N, Vanhoutie T, Vanhove W, Verdonk R. Percutaneous K-wire fixation versus palmar plating with locking screws for Colles' fractures. Acta Orthop Belg 2011; 77: 180-7.
21. Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A. Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury 2011; 42: 393-6.
22. Kwan K, Lau TW, Leung F. Operative treatment of distal radial fractures with locking plate system-a prospective study. Int Orthop 2011; 35: 389-94.
23. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. J Trauma 2010; 70: 1510-8.
24. Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Charissoux JL. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg Eur Vol 2010; 35: 646-51.
25. McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury 2011; 42: 162-6.
26. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29: 602-8.
27. Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil 2008; 22: 749-57.
28. Yasuda M, Ando Y. A new variable angled locking volar plate system for Colles' fracture: outcome study and time-course improvement of objective clinical variables. Hand Surg 2009; 14: 93-8.
29. Huard S, Blanchet N, Leclerc G. Fractures of the distal radius in patients over 70 years old:
Volar plates or K-wires? Chir Main 2010; 29: 236-41.
30. Voigt C, Lill H. What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly? Unfallchirurg 2006; 109: 848-54.
31. Orbay J. Volar plate fixation of distal radius fractures. Hand Clin 2005; 21: 347-54.
32. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78: 588-92.
33. Gavaskar AS, Muthukumar S, Chowdary N. Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial. J Hand Surg Eur Vol 2012; 37: 765-71.
34. Ng CY, McQueen MM. What are the radiological predictors of functional outcome following fractures of the distal radius? J Bone Joint Surg Br 2011; 93: 145-50.
35. Gravier R, Flecher X, Parratte S, Rapaie P, Argenson JN. Trans-styloid and intrafocal pinning for extra-articular extension fractures of the distal radius: prospective randomized postoperative comparison with simple intra-focal pinning. Rev Chir Orthop Reparatrice Appar Mot 2006; 92: 657-62.
36. Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1994; 76: 253-6.
37. Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg 1997; 5: 270-81
38. Beaulé PE, Dervin GF, Giachino AA, Rody K, Grabowski J, Fazekas A. Self-reported disability following distal radius fractures: the influence of hand dominance. J Hand Surg Am 2000; 25: 476-82.
39. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991; 73: 461-9.
40. Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology 1992; 184: 15-24.
41. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am 1993; 18: 492-8.
42. Porter M, Stockley I. Fractures of the distal radius: intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987; (220): 241-52.
43. Richly DA, Campbell DA. Distal radius and wrist. In: Rüedi TP, Buckley RE, Moran CG, editors. AO Principles of Fracture Management. 2nd edition. Vol. 2. New York, NY, USA: Thieme; 2007. pp. 660.
44. Trumble TE, Wagner W, Hanel DP, Vedder NB, Gilbert M. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am 1998; 23: 381-94.
45. Stein A, Katz S. Stabilization of comminuted fractures of the distal inch of the radius: Percutaneous pinning. Clin Orthop 1975; 108: 174-81.
46. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68: 647-59.
47. Forward DP, Davis TR, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic arthritis? J Bone Joint Surg Br 2008; 90: 629-37.
48. Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg Br 1993; 18: 45-9.
49. Beaton DE, van Eerd D, Smith P, van der Velde G, Cullen K, Kennedy CA, et al. Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability. J Clin Epidemiol 2011; 64: 487-96.
2. Diass JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilization in the treatment of Colles’ fractures. J Bone Joint Surg Br 1987; 69: 727-9.
3. Keating JF, Court-Brown CM, McQueen MM. Internal fixation of volar-displaced distal radial fractures. J Bone Joint Surg Br 1994; 76: 401-5.
4. Nana AD, Joshi A, Lichtman DM. Plating of the distal radius. J Am Acad Orthop Surg 2005; 13: 159-71.
5. Stevenson I, Carnegie CA, Christie EM, Kumar K, Johnstone AJ. Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy. J Trauma 2009; 67: 612-6.
6. Andrew H, Crenshaw JR. Fractures of shoulder arm and forearm. In: Canale S, editor. Campbell's operative orthopaedics. 10th ed. Philadelphia: Mosby; 2003. pp. 3058-66.
7. Green DP. Pins and plaster treatment of comminuted fractures of the distal end of the radius. J Bone Joint Surg Am 1975; 57: 304-10.
8. Weil WM, Trumble TE. Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization. Hand Clin 2005; 21: 317-28.
9. Fu YC, Chien SH, Huang PJ, Chen SK, Tien YC, Lin GT, et al. Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients. J Trauma 2006; 60: 330-3.
10. Spira E, Weigl K. The comminuted fracture of the distal end of the radius. Reconstr Surg Traumatol 1968; 11: 128-38.
11. Geller L, Bernstein M, Carli A, Berry G, Reindl R, Harvey E. Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures. Can J Surg 2009; 52: E161-6.
12. Jupiter JB, Marent-Huber M. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. J Bone Joint Surg Am 2009; 91: 55-65.
13. Larson AN, Rizzo M. Locking plate technology and its applications in upper extremity fracture care. Hand Clin 2007; 23: 269-78.
14. Lutsky K, McKeon K, Goldfarb C, Boyer M. Dorsal fixation of intra-articular distal radius fractures using 2.4-mm locking plates. Tech Hand Up Extrem Surg 2009; 13: 187-96.
15. Freeland AE, Luber KT. Biomechanics and biology of plate fixation of distal radius fractures. Hand Clin 2005; 21: 329-39.
16. Anglen J, Kyle RF, Marsh JL, Virkus WW, Watters WC, Keith MW, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg 2009; 17: 465-72.
17. Herron M, Faraj A, Craigen MA. Dorsal plating for displaced intraarticular fractures of the distal radius. Injury 2005; 36: 236.
18. Chou YC, Chen AC, Chen CY, Hsu YH, Wu CC. Dorsal and volar 2.4-mm titanium locking
plate fixation for AO type C3 dorsally comminuted distal radius fractures. J Hand Surg Am 2011; 36: 974-81.
19. Gereli A, Nalbantoğlu U, Kocaoğlu B, Türkmen M. Comparison of palmar locking plate and K-wire augmented external fixation for intra-articular and comminuted distal radius fractures. Acta Orthop Traumatol Turc 2010; 44: 212-9.
20. Hollevoet N, Vanhoutie T, Vanhove W, Verdonk R. Percutaneous K-wire fixation versus palmar plating with locking screws for Colles' fractures. Acta Orthop Belg 2011; 77: 180-7.
21. Khamaisy S, Weil YA, Safran O, Liebergall M, Mosheiff R, Khoury A. Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates. Injury 2011; 42: 393-6.
22. Kwan K, Lau TW, Leung F. Operative treatment of distal radial fractures with locking plate system-a prospective study. Int Orthop 2011; 35: 389-94.
23. Lattmann T, Meier C, Dietrich M, Forberger J, Platz A. Results of volar locking plate osteosynthesis for distal radial fractures. J Trauma 2010; 70: 1510-8.
24. Marcheix PS, Dotzis A, Benkö PE, Siegler J, Arnaud JP, Charissoux JL. Extension fractures of the distal radius in patients older than 50: a prospective randomized study comparing fixation using mixed pins or a palmar fixed-angle plate. J Hand Surg Eur Vol 2010; 35: 646-51.
25. McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury 2011; 42: 162-6.
26. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29: 602-8.
27. Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A, et al. Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Clin Rehabil 2008; 22: 749-57.
28. Yasuda M, Ando Y. A new variable angled locking volar plate system for Colles' fracture: outcome study and time-course improvement of objective clinical variables. Hand Surg 2009; 14: 93-8.
29. Huard S, Blanchet N, Leclerc G. Fractures of the distal radius in patients over 70 years old:
Volar plates or K-wires? Chir Main 2010; 29: 236-41.
30. Voigt C, Lill H. What advantages does volar plate fixation have over K-wire fixation for distal radius extension fractures in the elderly? Unfallchirurg 2006; 109: 848-54.
31. Orbay J. Volar plate fixation of distal radius fractures. Hand Clin 2005; 21: 347-54.
32. Rikli DA, Regazzoni P. Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg Br 1996; 78: 588-92.
33. Gavaskar AS, Muthukumar S, Chowdary N. Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial. J Hand Surg Eur Vol 2012; 37: 765-71.
34. Ng CY, McQueen MM. What are the radiological predictors of functional outcome following fractures of the distal radius? J Bone Joint Surg Br 2011; 93: 145-50.
35. Gravier R, Flecher X, Parratte S, Rapaie P, Argenson JN. Trans-styloid and intrafocal pinning for extra-articular extension fractures of the distal radius: prospective randomized postoperative comparison with simple intra-focal pinning. Rev Chir Orthop Reparatrice Appar Mot 2006; 92: 657-62.
36. Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1994; 76: 253-6.
37. Graham TJ. Surgical correction of malunited fractures of the distal radius. J Am Acad Orthop Surg 1997; 5: 270-81
38. Beaulé PE, Dervin GF, Giachino AA, Rody K, Grabowski J, Fazekas A. Self-reported disability following distal radius fractures: the influence of hand dominance. J Hand Surg Am 2000; 25: 476-82.
39. Jupiter JB. Fractures of the distal end of the radius. J Bone Joint Surg Am 1991; 73: 461-9.
40. Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology 1992; 184: 15-24.
41. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am 1993; 18: 492-8.
42. Porter M, Stockley I. Fractures of the distal radius: intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res 1987; (220): 241-52.
43. Richly DA, Campbell DA. Distal radius and wrist. In: Rüedi TP, Buckley RE, Moran CG, editors. AO Principles of Fracture Management. 2nd edition. Vol. 2. New York, NY, USA: Thieme; 2007. pp. 660.
44. Trumble TE, Wagner W, Hanel DP, Vedder NB, Gilbert M. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am 1998; 23: 381-94.
45. Stein A, Katz S. Stabilization of comminuted fractures of the distal inch of the radius: Percutaneous pinning. Clin Orthop 1975; 108: 174-81.
46. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68: 647-59.
47. Forward DP, Davis TR, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic arthritis? J Bone Joint Surg Br 2008; 90: 629-37.
48. Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg Br 1993; 18: 45-9.
49. Beaton DE, van Eerd D, Smith P, van der Velde G, Cullen K, Kennedy CA, et al. Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability. J Clin Epidemiol 2011; 64: 487-96.