Distal Radial Fracture Fixation in Adults using Intramedullary Elastic Wires Augmented with either Cast Immobilisation or External Fixation

Abstract

Introduction: The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation.

Materials and methods: A total of 42 patients (24 females and 18 males) aged 40 to 78 years who presented with displaced and unstable, closed or grade I open, extra- and/or intra-articular fractures of the distal radius were included in the study. Twenty-seven fractures were AO/OTA Type A2-A3 and 15 Type C1-C2. Twenty-four patients were treated with antegrade intramedullary (IM) fixation with elastic wires followed by cast immobilisation and 18 required an external fixator in lieu of casting.

Results: Final follow-up evaluation was conducted 12 months post-surgery using Sarmiento's modification of Lindstrom criteria and the demerit point system of Gartland and Werley. Successful fracture union was observed in all patients between eight to 14 weeks. Using Sarmiento's modification of Lindstrom criteria, 12 patients (28.6%) had excellent, 23 (54.8%) had good and 7 (16.6 %) had fair results. Based on the functional evaluation using the demerit point system of Gartland and Werley, 13 patients (31%) had excellent, 25 (59.5%) had good and four (9.5%) had fair results. None of the patients had a poor outcome using either of these criteria. Although a fracture union rate of 100% was confirmed clinically and radiographically, eight out of the 42 patients had minor complications in our study. One patient had uneventful IM migration of the wires, one patient reported a feeling of wire loosening, three patients complained of joint stiffness and soft tissue irritation, and three others reported on-going pain. The total cost of all implants used per case was less than INR 1,000.

Conclusions: Good to excellent functional and radiographic outcomes with easy to manage complications are achieved with the techniques described. Patient selection is key to determining which particular method should be prescribed in a given case.

Keywords: antegrade elastic wires; closed reduction; distal radial fracture; external fixation; intramedullary.

Fig. 1:

(a) Images showing unstable extra-articular distal radial fracture in both AP and lateral views, (b) closed reduction being attempted with counter-traction, (c) intra-articular K-wire for maintaining the reduction, (d) additional temporary K-wire for stabilisation of the reduced fracture until final fixation.

Fig. 2:

(a) Images showing a pre-bent wire prior to insertion, (b) exposure and drilling of radius for antegrade placement of wires, (c) and AP and lateral radiographs after final placement of the wires.

Fig. 3:

(a) AP and lateral radiographic images showing of a case with osteoporosis and comminuted distal radial fracture, (b) clinical photograph showing placement of an external fixator, (c) Radiographic views following final placement of IM wires and external fixator.

Fig. 4:

(a) Radiographic images showing union at the final follow-up with wires in-situ, and (b) following removal of wires.

Fig. 5:

Radiographic images showing series of pre-operative to post-operative progression for one patient without the use of external fixation; (a) images showing comminuted distal radial fracture with instability of the DRUJ, (b) K-wire pinning across the DRUJ, (c) post-operative images following fixation, (d) and AP and lateral images at final follow-up showing radiographic union.