Percutaneous Kirschner Wire fixation in distal radius metaphyseal fractures in children: does it change the overall outcome?

Abstract

Background and objectives: The aim of this study was to determine the effect of Kirschner wire fixation after closed reduction of radial metaphyseal fractures with high risk of redisplacement.

Patients and methods: In this retrospective study 40 cases were studied in two groups. In group 1 (n=20, average age 11.2 years), K-wire fixation was performed after closed reduction. In group 2 (n=20 average age 10.1 years), only plaster immobilization was applied following closed reduction. The compared clinical and radiological parameters were, pain, limb deformitiy, range of motion of the wrist, angulation of the fracture site, radial distal epipihyseal angle and severity of translation.

Results: Redisplacement rate was 10% in group 1 and 50% in group 2. This shows, Kirschner wire fixation has a positive effect in the maintanence of the initial reduction (p<0.05). Age, gender, reduction quality had no effect on redisplacement (p>0.05). Concerning the severity of translation, the risk of redisplacement increases in stage 3 (50%- 100%) and stage 4 (>100%) fractures (p<0,05). Concomitant complete ulnar fracture has also redisplacement risk (p<0.05). Redisplacement risk increases when the distance of fracture line to epiphyseal line was between 11-20 mm (p<0.05). There was no significiant difference between two groups after last evaluation based on radiological parameters and clinical results (p>0.05).

Conclusions: This study shows that Kirschner wire fixation prevents redisplacement in early follow-up of first three weeks but there is no superiority after 20 months follow-up in distal metaphyseal fractures of children.

Keywords: fracture; kirschner wire; metaphyseal; radius.

Figure 1. 10 year old boy had a radius distal metaphyseal fracture (a-b) and he was treated with closed reduction and splinting (Group-1) (c-d). The reduction was lost (e-f) during follow-up, however the family did not allow correction. The fracture was healed (g-h) with 10° loss of supination. The latest follow-up showed remodalization of the fracture (i-j)

Figure 2. 12 year old boy suffered from distal radius fracture (a-b) and he was treated with closed reduction and percutaneous Kirschner wire fixation (Group-2) (c-d). The fracture was healed without any sequela (e-f)