Artikel
K-Wire Fixation of Dorsally Displaced Distal Radius Fractures: A Biomechanical Study Comparing 4 Different K-Wire Configurations
Suche in Medline nach
Autoren
Veröffentlicht: | 10. Oktober 2017 |
---|
Gliederung
Text
Objectives: There is currently no consensus for the optimum configuration and number of K-wires to use for the stabilisation of dorsally displaced distal radius fractures despite being the commonest fracture of the upper limb. In this biomechanical study we compared the load to failure and stiffness of 4 common K-wire configurations, according to DRAFFT, in an extra-articular fracture model.
Method: Average fracture line position was measured on 50 consecutive AP and lateral radiographs of A2 type extra-articular fractures. This fracture was replicated in turkey tarsometatarsi and stabilised using 2 or 3 K-wires (1.6mm) in 4 different configurations (2 wire Kapandji, 3 wire modified Kapandji, 2 and 3 wire inter-fragmentary configurations). Following a power calculation 10 fracture models of each configuration underwent testing in flexion (with a dorsal displacing force) and axial compression.
Results: The 3 wire interfragmentary fixation was stiffer than the 3 wire Kapandji fixation (p=0.007) in axial compression and flexion (p=0.002). There was no difference in load to failure in flexion (p=0.158) or axial compression (p=0.627).
3 wire Kapandji stabilisation was significantly stronger than 2 wire Kapandji stabilisation in all parameters except stiffness in axial compression (p=0.819).
The 3 wire interfragmentary fixation was stiffer than the 2 wire fixation in axial compression (p=0.020) but not in flexion (p=0.103). There was no difference in load to failure in flexion (p=0.347) or axial compression (p=0.259).
Conclusion: The 3 wire interfragmentary configuration provides the most stable construct. We recommend to always use 3 K wires for percutaneous pinning of the distal radius especially in the application of the Kapandji technique. These results using a turkey bone model are likely to be applicable for patients with non osteoporotic extra-articular distal radius fractures.