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Closed Reduction and Percutaneous Pinning With Six Kirschner Wires for Intra-articular Distal Radius Fractures

March 01, 2020

Contributors: ANILKUMAR VIDYADHARAN, MBBS

Keywords: K-wire

The existing method for closed reduction does not allow for reduction of comminuted intra-articular distal radius fractures, and none of the existing methods for percutaneous pinning alone allow for fixation of comminuted intra-articular distal radius fractures. However, an innovative method for closed reduction and a new option for percutaneous pinning afford good results compared with current surgical treatment options. Anesthesia consists of a regional block/short-acting general anesthesia. Closed reduction is performed in four steps. Distraction is performed manually via a traction-and-countertraction technique, with the hand transferred to an assistant in two stages. The fracture fragments are compressed. The comminuted fragments are milked with the use of the thumb and the index finger from the metaphysial region to the radiocarpal joint. The final step involves repositioning of the distal radioulnar joint. Interfragmentary fixation is performed via the creation of two triangles by crossing six 1.5-mm Kirschner wires (K-wires) without a skin incision under C-arm guidance, avoiding the radiocarpal joint and encircling all the comminuted metaphyseal fragments, with incorporation of the ulnar head and the distal radioulnar joint. The first triangle is created by inserting the first K-wire from the radial styloid to the proximal fragment, passing the second K-wire from the lateral side of proximal fragment to the lunate fossa, and passing the third K-wire from the medial side of the ulnar head to the radial styloid. The second triangle is created by inserting three additional K-wires in the same orientation in another plane. The wires are bend 90° by applying pressure with the use of a K-wire bender in the skin and subcutaneous tissue and cut close to the short arm bend. The cut ends of the K-wires are kept in the subcutaneous plane by pulling the skin with the use of a thumb forceps for early joint movement. A modified wrist splint, which allows for complete range of finger movements and partial wrist movement, is applied for 3 to 4 weeks postoperatively, with intermittent removal allowed for radiocarpal joint exercises. The patient is discharged on the second postoperative day with active finger movements and partial wrist movement. Follow-up appointments are scheduled for 1 week, 3 weeks, and 6 weeks postoperatively. K-wires are removed at 6 weeks postoperatively. Follow-up appointments are scheduled for 3 months, 6 months, 1 year, 2 years, and 3 years postoperatively.