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ORIGINAL ARTICLE
Do Distal Radius Fractures Loose Reduction After K-wire Removal?
Harish V Kurup, *V. Mandalia, *K.A. Shaju, *A.R. Beaumont.

*Specialist Registrar in Orthopaedics, Salisbury District Hospital, SP2 8BJ, UK.

Address for Correspondence

Harish V Kurup
Specialist Registrar in Orthopaedics
Gwynedd
District Hospital
Bangor, North Wales LL57 2PW
Phone: +44 1248384384
Email:harishvk@yahoo.com

Abstract

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 were 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.
Keywords: Distal Radius Fracture, K wire fixation, loss of reduction, Radiological variables.

J.Orthopaedics 2006;3(4)e4

Introduction:

Fractures of the distal radius are the most common of all orthopaedic injuries accounting for nearly 20 % of all fractures presenting to emergency department [1]. Malunion of distal radius fractures lead to posttraumatic arthritis, mid carpal instability and pain [2]. Conservative treatment of minimally displaced and stable fractures of distal end of radius in elderly patients usually shows a good outcome but the treatment of severely displaced and unstable fractures has been controversial. The functional results in patients with significant radial shortening are poor. Fujii et al [3] recommended reduction of these fractures even in elderly patients. Percutaneous pinning is a simple, minimally invasive technique and is aimed at preventing redisplacement of the fragments. Wires are usually retained for 4 to 6 weeks. Most opponents of this technique claim that these fractures tend to collapse even after removal of wires [4] . The aim of our study was to find out whether these fractures loose reduction after removal of wires and whether this has any statistically significant association with any of the factors looked at.

Materials and methods

All patients who underwent K wire fixation for distal radius fractures in our department (June 2000 to May 2003) were included in this retrospective study. Palmar Tilt, Radial Tilt and Ulnar Variance were measured in these patients on plane radiographs [5]. The exclusion criteria were paediatric fractures, additional procedures like external fixation, nonavailability of satisfactory and comparable radiographs for measurement. The fractures were classified using AO classification. K wires were removed in outpatient clinic usually between 4-6 weeks depending on the preference of the consultant surgeon in charge of the patient. The loss of palmar tilt, radial tilt, and ulnar variance were measured from radiographs done prior to wire removal and later in follow up (3 to 4 months after injury). Only patients who were reviewed at a later date in clinic with a radiograph were included in this study.

The variables studied were age, sex, fracture type (AO), presence of ulnar fracture, type of K wires used, delay in fixation and period of wire stabilization. Continuous normally distributed data was analyzed using Chi-Square test, T-test and Fischer’s exact test using SPSS 10.0 software (SPSS Inc. Chicago, Illinois, USA). P value < 0.05 was considered to be significant for the purpose of this study.

Results

59 patients were included in this study of which 39 (66%) were females and 20(34%) males. Mean age of patients was 56 years (Range: 18 to 86 years). We divided patients into two age groups (<65 years and > or = 65 years). 56 % were < 65 years old and 44 % were > 65. [Table 1] Age ( P value 0.939) and sex ( P value 0.966) had no influence on the loss of radiological parameters after wire removal.
                              Table 1 : Loss of angles and Age / Sex

Category

(Number of patients )

Loss of angles – Mean ( Range )

Radial Tilt- o

Ulnar Variance- mm

Dorsal Tilt- o

< 65 years

(33)

2.2 (0-12)

1.1 (0-4)

2.2 (0-12)

> 65 years

(26)

2.0 (0-30)

1.5 (0-10)

3.1 (0-12)

P value 0.939

Male

(20)

2.3 (0-12)

1.4 (0-4)

2.1 (0-12)

Female

(39)

2.8 (0-30)

1.3 (0-10)

2.9 (0-12)

P value 0.966

All patients

(59)

2.6 (0 – 30)

1.3 (0-10)

2.6(0-12)

Fractures were classified using AO system. No patients were in class B, due to different treatment protocol followed in these. AO Class of the fracture had no influence on loss of angles after wire removal (P value 0.923). [Table 2]. Most fractures were fixed on first week and some were delayed to second week or still later. The delay in fixation did not appear to influence loss of reduction after wire removal (P value 0.803). [ Table 3] Some patients had one or two Kapandji intra-focal wires in addition to percutaneous wires. Use of Kapandji wire did not provide a statistically significant (P value 0.514) difference in the loss of angles.[Table 4]  Wires were mostly removed in outpatients after 5 or 6 weeks with some at 4 and some after 6 weeks. The duration of fixation had no association with the radiological outcome (P value 0.905) [Table 5]

 Table 2 : Loss of angles and AO Class

AO Class

(Number of patients)

Loss of angles – Mean ( Range )

Radial Tilt- o

Ulnar Variance- mm

Dorsal Tilt- o

A2

(10)

5.4 (0 – 30)

1.1 (0 – 2)

2.7 (0 – 12)

A3

(18)

1.7 (0 – 4)

1.2 (0 – 4)

3.4 (0 – 12)

C1

(14)

1.8(0 – 6)

0.9 (0 – 2)

2.5 (0 – 8)

C2

(12)

1.5 (0 – 6)

1.8 (0 – 10)

1.6 (0 – 6)

C3

(5)

4 (0 – 12)

1.2 (0 – 4)

3.0 (0 – 4)

P value 0.923

 Table 3 : Loss of angles and delay in fixation

Delay in fixation

( Number of patients )

Loss of angles – Mean ( Range )

Radial Tilt- o

Ulnar Variance- mm

Dorsal Tilt- o

< 1 week

(40)

2.8

(0-30)

1.3

(0-8)

2.8

(0-12)

>1 & < 2 weeks

(17)

2.2

(0-8)

1.4

(0-10)

2.9

(0-8)

> 2 weeks

(2)

1

(0-2)

1

(0-2)

0

(0)

P value 0.803

 Table 4 : Loss of angles and type of wire

 

Type of K-wire

( Number of patients )

Loss of angles – Mean ( Range )

Radial Tilt- o

Ulnar Variance- mm

Dorsal Tilt- o

With Kapandji wire

(8)

1.3

(0-2)

0.5

(0-2)

4.0

(0-12)

Without  Kapandji wire

(51)

2.8

(0-30)

1.4

(0-10)

2.4

(0-12)

P value 0.514

 Table 5 : Loss of angles and timing of wire removal

Timing of K-wire removal

( Number of patients)

Loss of angles – Mean ( Range )

Radial Tilt- o

Ulnar Variance- mm

Dorsal Tilt- o

4 weeks

(8)

1.5

(0-4)

0.9

(0-4)

1.5

(0-4)

5 weeks

(12)

3.6

(0-12)

1.0

(0-2)

3.2

(0-12)

6 weeks

(33)

1.8

(0-6)

1.2

(0-8)

2.7

(0-12)

> 6 weeks

(6)

6.7

(0-30)

2.7

(0-10)

2.2

(0-4)

P value 0.905

 Conclusions

We make the following recommendations based on our findings:

  1. Junior doctors should be encouraged to do re-audits along with new projects.

  2. Audits should identify the person responsible for the planned change and the progress made should be discussed in the following meeting.

  3. Every department should audit its own audits periodically to review changing practice and identify defects in the system.

References

  1. Currie IS, Paterson-Brown S. (1998) Clinical audit; who is auditing who? Scott Med J. 43(6):185-8.
  2. Johnston G, Davies HT, Crombie IK. (2000) Improving care or professional advantage? What makes clinicians do audit and how well do they fare? Health Bull (Edinb). 58(4):276-85.
  3. Lough JR, Mckay J, Murray TS. (1995) Audit: trainers' and trainees' attitudes and experiences. Med Educ. 29(1):85-90.
  4. McCarthy MJ, Byrne GJ. (1997) Surgical audit: the junior doctors' viewpoint.J R Coll Surg Edinb. 42(5):317-8.
  5. Principles for Best Practice in Clinical Audit. NICE. (2002) Radcliffe Medical Press.
  6. Smith HE, Russell GI, Frew AJ, et al. (1992) Medical audit: the differing perspectives of managers and clinicians. J R Coll Physicians Lond. 26(2):177-80.
  7. Tabandeh H, Thompson GM. (1995) Auditing ophthalmology audits. Eye. 9:1-5.

 

This is a peer reviewed paper 

Please cite as : Harish V Kurup: Do distal radius fractures loose reduction after K-wire removal?

J.Orthopaedics 2006;3(4)e4

URL: http://www.jortho.org/2006/3/4/e4

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