Percutaneous K-wires vs palmar locking plate fixation for different types of distal radial fractures: a comparison of the outcomes of two methods to controll our guidelines

Abstract

The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation.

Patients and Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures.

Results: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group.

Conclusion: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.

Zusammenfassung

Hintergrund: Die Studie überprüft die institutseigene Therapierichtlinie zur Behandlung distaler Radiusfrakturen anhand der Behandlungsergebnisse. Gemäß unserer Therapierichtlinie wurden A2-, A3-, B1-, B2-C1- und einige C2-Frakturen nach der AO-Klassifikationen mittels K-Draht-Osteosynthese versorgt, B3- und einige B2- sowie C3- und einige C2-Frakturen mittels palmarer winkelstabiler Plattenosteosynthese.

Patienten und Methoden: Von 467 Patienten erhielten entsprechend 363 eine K-Draht-Osteosynthese und 104 eine palmare Plattenosteosynthese. Klinische und radiologische Ergebnisse wurden nach 3 und 12 Monaten überprüft.

Ergebnisse: Bei der Untersuchung 3 Monate postoperativ zeigten Patienten mit einer palmaren Plattenosteosynthese statistisch signifikant bessere Ergebnisse punkto grober Kraft und DASH-Score, nach 12 Monaten statistisch signifikant bessere Ergebnisse bei der Handgelenksstreckung- und –beugung. Statistisch signifikant bessere Ergebnisse bei palmaren Plattenosteosynthesen wurden auch für die Palmar- und Ulnarinklination der Radiusgelenkfläche festgestellt. Das klinische Ergebnis beeinflussende sekundäre Dislokationen wurden bei 10 Patienten registriert, alle 10 waren mittels K-Draht-Osteosynthese versorgt worden.

Schlussfolgerung: Die winkelstabile palmare Plattenosteosynthese führt selbst bei komplexeren distalen Radiusfrakturen zu besseren klinischen und radiologischen Ergebnissen als die K-Draht-Osteosynthese bei einfachen distalen Radiusfrakturen.

Key words

Distal radius fracture - K-wire fixation - locking plate fixation

Schlüsselwörter

Distale Radiusfraktur - K-Draht-Osteosynthese - winkelstabile Plattenosteosynthese

• References

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