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Aktuelle Traumatol 2006; 36(2): 78-85
DOI: 10.1055/s-2006-923920
Varia

Georg Thieme Verlag KG Stuttgart · New York

Perkutane Fixation des distalen Radius - Sind perkutane Spickdrahttechniken noch indiziert?

Percutaneous Osteosynthesis of the Distal Radius - Are Pinning Techniques Still Indicated?J. Andermahr1 , K. Mader2 , A. Elsner3 , A. Prokop1 , J. Isenberg1 , A. Jubel1
  • 1Klinik für Unfall-, Hand- und Wiederherstellungschirurgie (Direktor: Prof. Dr. K. E. Rehm), Universitätskliniken Köln
  • 2Klinik für Unfall-, Hand und Wiederherstellungschirurgie (Direktor: Prof. Dr. D. Pennig), St. Vinzenz-Hospital, Köln
  • 3Klinik für Orthopädie und Traumatologie des Kantonsspitales Nidwalden (Direktor: Dr. A. Remiger), Stans, Schweiz
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Publikationsverlauf

Publikationsdatum:
25. April 2006 (online)

    Lizenzen und Reprints

Zusammenfassung

Bei der häufigsten Fraktur des menschlichen Körpers, der distalen Radiusfraktur, konkurrieren derzeit viele verschiedene operative Therapiekonzepte. Neben den invasiven Methoden wie z. B. die Plattenosteosynthese wird die spezielle Indikationsstellung zur geschlossenen Reposition und minimalinvasiven Osteosynthese mit K-Drähten anhand eigener Daten und der Literaturübersicht erörtert. Die K-Draht-Osteosynthese (KDO) ist eine Alternative zur Plattenosteosynthese bei A2- und A3-Frakturen. Bei C3-Frakturen spielt sie eine wichtige Rolle in der Kombination mit anderen Osteosyntheseverfahren wie Plattenosteosynthese oder Fixateur externe. Die KDO ist indiziert bei kindlichen Frakturen, die mehr als Schaftbreite disloziert sind. Alte Patienten mit C-Frakturen haben ein signifikant besseres funktionelles Outcome mit KDO vs. konservativ. Die KDO ist 60 % billiger als eine moderne (LCP) Plattenosteosynthese. Sie ist extrem kostengünstig und bringt bei korrekter Indikationsstellung ein zufriedenstellendes funktionelles Ergebnis.

Abstract

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. There are aggressive concepts with open reduction and internal fixation with plates and minimally invasive pinning after closed reduction. The latter treatment concept is evaluated using own data and results from the literature. Percutaneous pinning is used as treatment alternativ in ASIF A2 and A3 fractures. In C3 type fracture they can play an important part as supplementary adjunct in combination with external fixation or plates. Furthermore percutaneous pinning techniques can be used in distal radius fractures in children with dislocation. Elderly patients with type C fractures do gain superior results in functional outcome using this technique than with reduction and casting alone. Percutaneous pinning is very cost-effective in comparison to plating. When using correct indications this technique can provide excellent functional results.

Literatur

  • 1 Barton J. Views and treatment of an important injury of the wrist.  Medi Examiner. 1838;  365-368
    PubMedGoogle Scholar
  • 2 Benoist L A, Freeland A E. Buttress pinning in the unstable distal radial fracture. A modification of the Kapandji technique.  J Hand Surg [Br]. 1995;  20 82-96
    PubMedGoogle Scholar
  • 3 Cassidy C. et al . Norian SRS cement compared with conventional fixation in distal radial fractures. A randomized study.  J Bone Joint Surg [Am]. 2003;  85 2127-2137
    PubMedGoogle Scholar
  • 4 Chen A C, Chan Y S, Yuan L J, Ye W L, Lee M S, Chao E K. Arthroscopically assisted osteosynthesis of complex intra-articular fractures of the distal radius.  J Trauma. 2002;  53 354-359
    PubMedGoogle Scholar
  • 5 Choi K Y, Chan W S, Lam T P, Cheng J C. Percutaneous Kirschner-wire pinning for severely displaced distal radial fractures in children. A report of 157 cases.  J Bone Joint Surg [Br]. 1995;  77 797-801
    PubMedGoogle Scholar
  • 6 Colles A. On the fracture of the carpal extremity of the radius.  Edinburgh Med Surg J. 1814;  10 182-186
    PubMedGoogle Scholar
  • 7 de Buys Roessingh A S, Reinberg O. Open or closed pinning for distal humerus fractures in children?.  Swiss Surg. 2003;  9 76-81
    CrossrefPubMedGoogle Scholar
  • 8 Dee W, Klein W, Rieger H. Reduction techniques in distal radius fractures.  Injury. 2000;  31 (Suppl 1) 48-55
    CrossrefPubMedGoogle Scholar
  • 9 Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation.  J Bone Joint Surg [Am]. 1999;  81 1093-1110
    PubMedGoogle Scholar
  • 10 Espen D. [Combined palmar and dorsal approach for complex distal radius fractures.]  Handchir Mikrochir Plast Chir. 2003;  35 22-30
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Fernandez D L. Distal radius fracture: the rationale of a classification.  Chir Main. 2001;  20 411-425
    CrossrefPubMedGoogle Scholar
  • 12 Fernandez D L, Jupiter J B. Fractures of the Distal Radius. New York; Springer-Verlag 1995
    Google Scholar
  • 13 Fernandez J J, Gruen G S, Herndon J H. Outcome of distal radius fractures using the short form 36 health survey.  Clin Orthop Relat Res. 1997;  341 36-41
    PubMedGoogle Scholar
  • 14 Freeland A E, Geissler W B. The arthroscopic management of intra-articular distal radius fractures.  Hand Surg. 2000;  5 93-102
    CrossrefPubMedGoogle Scholar
  • 15 Freeland A E, Sud V, Jemison D M. Early wrist arthrodesis for irreparable intra-articular distal radial fractures.  Hand Surg. 2000;  5 113-118
    CrossrefPubMedGoogle Scholar
  • 16 Fritz T, Heyer T, Krieglstein C, Mattern R, Kallieris D, Friedl W. [Biomechanics of combined Kirschner wire osteosynthesis in the human model of unstable dorsal, distal radius fractures (Colles type).]  Chirurg. 1997;  68 496-502
    CrossrefPubMedGoogle Scholar
  • 17 Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T, Terai T. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results.  J Orthop Surg (Hong Kong). 2002;  10 9-15
    PubMedGoogle Scholar
  • 18 Gausepohl T, Worner S, Pennig D, Koebke J. Extraarticular external fixation in distal radius fractures pinplacement in osteoporotic bone.  Injury. 2001;  32 (Suppl 4) 79-85
    PubMedGoogle Scholar
  • 19 Geissler W B, Fernandes D. Percutaneous and limited open reduction of intra-articular distal radial fractures.  Hand Surg. 2000;  5 85-92
    CrossrefPubMedGoogle Scholar
  • 20 Guichet J M, Casar R S. Mechanical characterization of a totally intramedullary gradual elongation nail.  Clin Orthop Relat Res. 1997;  337 281-290
    PubMedGoogle Scholar
  • 21 Guichet J M, Moller C C, Dautel G, Lascombes P. A modified Kapandji procedure for Smith's fracture in children.  J Bone Joint Surg [Br]. 1997;  79 734-737
    CrossrefPubMedGoogle Scholar
  • 22 Handoll H H, Madhok R, Howe T E. Rehabilitation for distal radial fractures in adults.  Cochrane Database Syst Rev. 2002;  2 CD003324
    PubMedGoogle Scholar
  • 23 Harness N, Ring D, Jupiter J B. Volar Barton's fractures with concomitant dorsal fracture in older patients.  J Hand Surg [Am]. 2004;  29 439-445
    CrossrefPubMedGoogle Scholar
  • 24 Higgins T F, Dodds S D, Wolfe S W. A biomechanical analysis of fixation of intra-articular distal radial fractures with calcium-phosphate bone cement.  J Bone Joint Surg [Am]. 2002;  84 1579-1586
    PubMedGoogle Scholar
  • 25 Jupiter J B. Complex articular fractures of the distal radius: classification and management.  J Am Acad Orthop Surg. 1997;  5 119-129
    CrossrefPubMedGoogle Scholar
  • 26 Jupiter J B. Fractures of the distal end of the radius.  J Bone Joint Surg [Am]. 1991;  73 461-469
    PubMedGoogle Scholar
  • 27 Jupiter J B, Fernandez D L. Complications following distal radial fractures.  Instr Course Lect. 2002;  51 203-219
    PubMedGoogle Scholar
  • 28 Jupiter J B, Ring D. Operative treatment of post-traumatic proximal radioulnar synostosis.  J Bone Joint Surg [Am]. 1998;  80 248-257
    PubMedGoogle Scholar
  • 29 Jupiter J B, Ring D, Weitzel P P. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years.  J Hand Surg [Am]. 2002;  27 714-723
    PubMedGoogle Scholar
  • 30 Jupiter J B, Winters S, Sigman S, Lowe C, Pappas C, Ladd A L, Van Wagoner M, Smith S T. Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report.  J Orthop Trauma. 1997;  11 110-116
    CrossrefPubMedGoogle Scholar
  • 31 Kakarlapudi T K, Santini A, Shahane S A, Douglas D. The cost of treatment of distal radial fractures.  Injury. 2000;  31 229-232
    CrossrefPubMedGoogle Scholar
  • 32 Kapandji A. [Biomechanics of the carpus and the wrist.]  Ann Chir Main. 1987;  6 147-169
    CrossrefPubMedGoogle Scholar
  • 33 Kapandji A. [Internal fixation by double intrafocal plate. Functional treatment of non articular fractures of the lower end of the radius (author's transl.).]  Ann Chir. 1976;  30 903-908
    PubMedGoogle Scholar
  • 34 Kapandji A. [Intra-focal pinning of fractures of the distal end of the radius 10 years later.]  Ann Chir Main. 1987;  6 57-63
    CrossrefPubMedGoogle Scholar
  • 35 Kiely P D, Kiely P J, Stephens M M, Dowling F E. Atypical distal radial fractures in children.  J Pediatr Orthop B. 2004;  13 202-205
    PubMedGoogle Scholar
  • 36 Kopylov P, Adalberth K, Jonsson K, Aspenberg P. Norian SRS versus functional treatment in redisplaced distal radial fractures: a randomized study in 20 patients.  J Hand Surg [Br]. 2002;  27 538-541
    CrossrefPubMedGoogle Scholar
  • 37 Kopylov P, Aspenberg P, Yuan X, Ryd L. Radiostereometric analysis of distal radial fracture displacement during treatment: a randomized study comparing Norian SRS and external fixation in 23 patients.  Acta Orthop Scand. 2001;  72 57-61
    CrossrefPubMedGoogle Scholar
  • 38 Kopylov P, Jonsson K, Thorngren K G, Aspenberg P. Injectable calcium phosphate in the treatment of distal radial fractures.  J Hand Surg [Br]. 1996;  21 768-771
    CrossrefPubMedGoogle Scholar
  • 39 Lenoble E, Dumontier C, Goutallier D, Apoil A. Fracture of the distal radius. A prospective comparison between trans-styloid and Kapandji fixations.  J Bone Joint Surg [Br]. 1995;  77 562-567
    PubMedGoogle Scholar
  • 40 Lindau T, Adlercreutz C, Aspenberg P. Cartilage injuries in distal radial fractures.  Acta Orthop Scand. 2003;  74 327-331
    CrossrefPubMedGoogle Scholar
  • 41 Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures.  J Hand Surg [Am]. 2000;  25 464-468
    CrossrefPubMedGoogle Scholar
  • 42 Low C K, Chew W Y. Results of Sauve-Kapandji procedure.  Singapore Med J. 2002;  43 135-137
    PubMedGoogle Scholar
  • 43 Low C K, Liau K H, Chew W Y. Results of distal radial fractures treated by intra-focal pin fixation.  Ann Acad Med Singapore. 2001;  30 573-576
    PubMedGoogle Scholar
  • 44 Nonnenmacher J, Neumeier K. [Intrafocal wiring of fractures of the wrist joint.]  Handchir Mikrochir Plast Chir. 1987;  19 67-70
    PubMedGoogle Scholar
  • 45 Pennig D, Gausepohl T, Mader K. Corrective osteotomies in malunited distal radius fractures: external fixation as one stage and hemicallotasis procedures.  Injury. 2000;  31 (Suppl 1) 78-91
    CrossrefPubMedGoogle Scholar
  • 46 Peyroux L M, Dunaud J L, Caron M, Ben Slamia, Kharrat M. The Kapandji technique and its evolution in the treatment of fractures of the distal end of the radius. Report on a series of 159 cases.  Ann Chir Main. 1987;  6 109-122
    CrossrefPubMedGoogle Scholar
  • 47 Prommersberger K J, Fernandez D L, Ring D, Jupiter J B, Lanz U B. Open reduction and internal fixation of un-united fractures of the distal radius: does the size of the distal fragment affect the result?.  Chir Main. 2002;  21 113-123
    CrossrefPubMedGoogle Scholar
  • 48 Prommersberger K J, Froehner S C, Schmitt R R, Lanz U B. Rotational deformity in malunited fractures of the distal radius.  J Hand Surg [Am]. 2004;  29 110-115
    PubMedGoogle Scholar
  • 49 Prommersberger K J, van Schoonhoven J, Lanz U B. Outcome after corrective osteotomy for malunited fractures of the distal end of the radius.  J Hand Surg [Br]. 2002;  27 55-60
    CrossrefPubMedGoogle Scholar
  • 50 Prommersberger K J, van Schoonhoven J, Laubach S. [Pseudarthroses after distal radius fractures. What is the role of the distal radioulnar joint?].  Handchir Mikrochir Plast Chir. 2000;  32 379-389
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 51 Rauch F, Tutlewski B, Fricke O, Rieger-Wettengl G, Schauseil-Zipf U, Herkenrath P, Neu C M, Schoenau E. Analysis of cancellous bone turnover by multiple slice analysis at distal radius: a study using peripheral quantitative computed tomography.  J Clin Densitom. 2001;  4 257-262
    CrossrefPubMedGoogle Scholar
  • 52 Rayhack J M. The history and evolution of percutaneous pinning of displaced distal radius fractures.  Orthop Clin North [Am]. 1993;  24 287-300
    PubMedGoogle Scholar
  • 53 Ring D. Treatment of the neglected distal radius fracture.  Clin Orthop Relat Res. 2005;  431 85-92
    PubMedGoogle Scholar
  • 54 Ring D, Jupiter J B. Percutaneous and limited open fixation of fractures of the distal radius.  Clin Orthop Relat Res. 2000;  375 105-115
    PubMedGoogle Scholar
  • 55 Ring D, Jupiter J B. Treatment of osteoporotic distal radius fractures.  Osteoporos Int. 2004;  8 80-84
    PubMedGoogle Scholar
  • 56 Ring D, Jupiter J B, Brennwald J, Buchler U, Hastings 2nd H. Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures.  J Hand Surg [Am]. 1997;  22 777-784
    PubMedGoogle Scholar
  • 57 Rodriguez-Merchan E C. Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age.  J Orthop Trauma. 1997;  11 212-217
    CrossrefPubMedGoogle Scholar
  • 58 Ruch D S, Vallee J, Poehling G G, Smith B P, Kuzma G R. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures.  Arthroscopy. 2004;  20 225-230
    CrossrefPubMedGoogle Scholar
  • 59 Ruch D S, Weiland A J, Wolfe S W, Geissler W B, Cohen M S, Jupiter J B. Current concepts in the treatment of distal radial fractures.  Instr Course Lect. 2004;  53 389-401
    PubMedGoogle Scholar
  • 60 Rüedi T P, Murphy W M. AO Principles of Fracture Management. Stuttgart, New York; Thieme-Verlag 2000
    Google Scholar
  • 61 Sanchez-Sotelo J, Munuera L, Madero R. Treatment of fractures of the distal radius with a remodellable bone cement: a prospective, randomised study using Norian SRS.  J Bone Joint Surg [Br]. 2000;  82 856-863
    PubMedGoogle Scholar
  • 62 Silverman A T, Paksima N. Biplanar Kapandji intrafocal pinning of distal radial fractures.  Am J Orthop. 2004;  33 40-41
    PubMedGoogle Scholar
  • 63 Tyllianakis M, Giannikas D, Panagopoulos A, Panagiotopoulos E, Lambiris E. Use of injectable calcium phosphate in the treatment of intra-articular distal radius fractures.  Orthopedics. 2002;  25 311-315
    PubMedGoogle Scholar
  • 64 Van Cauwelaert de Wyels J, De Smet L. Corrective osteotomy for malunion of the distal radius in young and middle-aged patients: an outcome study.  Chir Main. 2003;  22 84-89
    CrossrefPubMedGoogle Scholar
  • 65 von Laer L, Hasler C. [Spontaneous corrections, growth disorders and post-traumatic deformities after fractures in the area of the forearm of the growing skeleton.]  Handchir Mikrochir Plast Chir. 2000;  32 231-241
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 66 Walton N P, Brammar T J, Hutchinson J, Raj D, Coleman N P. Treatment of unstable distal radial fractures by intrafocal, intramedullary K-wires.  Injury. 2001;  32 383-389
    CrossrefPubMedGoogle Scholar
  • 67 Willenegger H, Guggenbuhl A. [Operative treatment of certain cases of distal radius fracture.]  Helv Chir Acta. 1959;  26 81-94
    PubMedGoogle Scholar
  • 68 Wustner-Hofmann M C, Schober F, Hofmann A K. [The value of the Kapandji-Sauve procedure with considering clinical results and measurement of bone density. A clinical study.]  Handchir Mikrochir Plast Chir. 2003;  35 147-156
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 69 Yetkinler D N, Ladd A L, Poser R D, Constantz B R, Carter D. Biomechanical evaluation of fixation of intra-articular fractures of the distal part of the radius in cadavera: Kirschner wires compared with calcium-phosphate bone cement.  J Bone Joint Surg [Am]. 1999;  81 391-399
    PubMedGoogle Scholar
  • 70 Youm Y, Flatt A E. Kinematics of the wrist.  Clin Orthop. 1980;  149 21-32
    PubMedGoogle Scholar
  • 71 Young C F, Nanu A M, Checketts R G. Seven-year outcome following Colles' type distal radial fracture. A comparison of two treatment methods.  J Hand Surg [Br]. 2003;  28 422-426
    CrossrefPubMedGoogle Scholar
  • 72 Zimmermann R, Gabl M, Lutz M, Angermann P, Gschwentner M, Pechlaner S. Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women.  Arch Orthop Trauma Surg. 2003;  123 22-27
    PubMedGoogle Scholar
  • 73 Zimmermann R, Gschwentner M, Pechlaner S, Gabl M. Remodeling capacity and functional outcome of palmarly versus dorsally displaced pediatric radius fractures in the distal one-third.  Arch Orthop Trauma Surg. 2004;  124 42-48
    CrossrefPubMedGoogle Scholar

Priv.-Doz. Dr. med. Jonas Andermahr

Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie
Universitätskliniken Köln

Joseph-Stelzmann-Straße 9

50931 Köln

Telefon: 0221/478-4802

Fax: 0221/478-4835

eMail: jandermahr@t-online.de

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