Association between radiological collapse and angle of K-wire placement in distal end radius fractures: a prospective comparative cohort study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i2.2726Keywords:
Distal radius fracture, K-wire fixation, radiological collapse, ulnar variance, comparative cohort study, Gartland and Werley score.Abstract
Background
Distal radius fractures are common adult orthopaedic injuries. Stability after closed reduction and percutaneous K-wire fixation depends on fracture morphology, bone quality, and wire configuration, but evidence comparing high-angle and low-angle pin placement is limited.
Objectives
To compare radiological collapse, ulnar variance, anatomical restoration, and 6-month functional outcome between high-angle and low-angle K-wire fixation groups.
Methods
This prospective comparative cohort study enrolled 60 consecutive patients with closed distal radius fractures treated by closed reduction and percutaneous K-wire fixation at a single tertiary orthopaedic centre. Thirty patients were classified as high-angle (>45°) and 30 as low-angle (<45°) according to the radial styloid K-wire trajectory. Serial radiographs and 6-month anatomical and functional outcomes were evaluated. Pearson chi-square tests were used for categorical comparisons.
Results
The cohort included 41 (68.3%) women and 19 (31.7%) men. At 6 months, a favourable ulnar variance/anatomical category was observed in 11/30 (36.7%) high-angle and 18/30 (60.0%) low-angle patients; radiological collapse was recorded in 19/30 (63.3%) and 12/30 (40.0%), respectively. The association between pin-angle group and categorical collapse did not reach statistical significance (χ²=3.27, df=1, p=.071; odds ratio=2.59, 95% CI 0.91-7.34 for high versus low angle). Good-to-excellent functional outcomes occurred in 25/30 (83.3%) and 28/30 (93.3%) patients, and the complete 6-month functional score distribution was not associated with angle group (χ²=6.88, df=10, p=.737). All fractures united, and 52 (86.7%) patients had no complication.
Conclusion
Low-angle fixation showed a lower proportion of categorical radiological collapse and a higher proportion of favourable anatomical and functional outcomes, but the differences were not statistically significant. Both techniques achieved union and acceptable recovery. The findings are exploratory because continuous changes in radial height, radial inclination, and volar tilt were unavailable for analysis.
Recommendations
Pin angle should be selected with attention to fracture geometry, bicortical purchase, soft-tissue safety, and serial radiographic monitoring.
References
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-125. PMID: 22554654. https://doi.org/10.1016/j.hcl.2012.02.001
MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-145. PMID: 27264899. https://doi.org/10.1016/j.jht.2016.03.003
Karantana A, Handoll HHG, Sabouni A. Percutaneous pinning for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2020;2(2):CD006080. PMID: 32032439. https://doi.org/10.1002/14651858.CD006080.pub3
Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Joint Surg Br. 2005;87(6):837-840. PMID: 15911669. https://doi.org/10.1302/0301-620X.87B6.15608
Clancey GJ. Percutaneous Kirschner-wire fixation of Colles fractures. A prospective study of thirty cases. J Bone Joint Surg Am. 1984;66(7):1008-1014. PMID: 6480630. https://doi.org/10.2106/00004623-198466070-00006
Munson GO, Gainor BJ. Percutaneous pinning of distal radius fractures. J Trauma. 1981;21(12):1032-1035. PMID: 7321064. https://doi.org/10.1097/00005373-198112000-00005
Naidu SH, Capo JT, Moulton M, Ciccone W 2nd, Radin A. Percutaneous pinning of distal radius fractures: a biomechanical study. J Hand Surg Am. 1997;22(2):252-257. PMID: 9195422. https://doi.org/10.1016/S0363-5023(97)80159-1
Chia B, Catalano LW 3rd, Glickel SZ, Barron OA, Meier K. Percutaneous pinning of distal radius fractures: an anatomic study demonstrating the proximity of K-wires to structures at risk. J Hand Surg Am. 2009;34(6):1014-1020. PMID: 19643288. https://doi.org/10.1016/j.jhsa.2009.04.004
Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1951;33-A(4):895-907. PMID: 14880544. https://doi.org/10.2106/00004623-195133040-00009
Plant CE, Hickson C, Hedley H, Parsons NR, Costa ML. Is it time to revisit the AO classification of fractures of the distal radius? Inter- and intra-observer reliability of the AO classification. Bone Joint J. 2015;97-B(6):818-823. PMID: 26033063. https://doi.org/10.1302/0301-620X.97B6.33844
Chen CE, Juhn RJ, Ko JY. Treatment of distal radius fractures with percutaneous pinning and pin-in-plaster. Hand (N Y). 2008;3(3):245-250. PMID: 18780104. https://doi.org/10.1007/s11552-008-9093-3
Rosati M, Bertagnini S, Digrandi G, Sala C. Percutaneous pinning for fractures of the distal radius. Acta Orthop Belg. 2006;72(2):138-146. PMID: 16768255.
Costa ML, Achten J, Parsons NR, Rangan A, Griffin D, Tubeuf S, et al. Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ. 2014;349:g4807. PMID: 25096595. https://doi.org/10.1136/bmj.g4807
Karantana A, Downing ND, Forward DP, Hatton M, Taylor AM, Scammell BE, et al. Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial. J Bone Joint Surg Am. 2013;95(19):1737-1744. PMID: 24088965. https://doi.org/10.2106/JBJS.L.00232
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