Closed Reduction and K-Wiring With the Kapandji Technique for Completely Displaced Pediatric Distal Radial Fractures

Abstract

In completely displaced pediatric distal radial fractures, achieving satisfactory reduction with closed manipulation and maintenance of reduction with casting is difficult. Although the Kapandji technique of K-wiring is widely practiced for distal radial fracture fixation in adults, it is rarely used in pediatric acute fractures. Forty-six completely displaced distal radial fractures in children 7 to 14 years old were treated with closed reduction and K-wire fixation. One or 2 intrafocal K-wires were used to lever out and reduce the distal fragment's posterior and radial translation. One or 2 extrafocal K-wires were used to augment intrafocal fixation. Postoperative immobilization was enforced for 3 to 6 weeks (with a short arm plaster of Paris cast for the first half of the time and a removable wrist splint for the second half), after which time the K-wires were removed. Patients were followed for a minimum of 4 months. Mean patient age was 9.5 years. Near-anatomical reduction was achieved easily with the intrafocal leverage technique in all fractures. Mean procedure time for K-wiring was 7 minutes. On follow-up, there was no loss of reduction; remanipulation was not performed in any case. There were no pin-related complications. All fractures healed, and full function of the wrist and forearm was achieved in every case. The Kapandji K-wire technique consistently achieves easy and near-anatomical closed reduction by a leverage reduction method in completely displaced pediatric distal radial fractures. Reduction is maintained throughout the fracture-healing period. The casting duration can be reduced without loss of reduction, and good functional results can be obtained.

Predictors for losing reduction after reposition in conservatively treated both-bone forearm fractures in 38 children

“…2,5,17,26,34,39 The incidence of reduction loss can be lowered considerably by surgically adding stability to those fractures that are most prone to lose reduction. 2,40 The results of this study showed that fractures with initial complete fracture displacement and any residual fracture displacement (>0%) are prone to lose reduction and require a more frequent follow-up schedule, or even a more initial stable surgical treatment regime.…”

Prying reduction with mosquito forceps versus limited open reduction for irreducible distal radius‐ulna fractures in older children: a retrospective study

“…However, open reduction is traumatic, bleeding, leaving surgical scars, and even a certain probability of damaging epiphysis, resulting in growth arrest and other serious complications. Some scholars used minimally invasive prying reduction technique of Kirschner wires in the treatment of irreducible distal radius fractures in children [19,20]. Pavone et al reported the midterm results of surgical treatment of displaced proximal humeral fractures in children [21].…”

Fixation of unstable distal radius fractures by using expandable Intramedullary nailing system in adult patients

“… 19 Distal radius fractures can usually be treated by closed reduction and non-invasive fixation in most of the cases. 20 However, for extra-articular or minimally displaced intra-articular fractures that are not stable with closed reduction and external fixation, surgical fixation should be performed. Likewise, in the present study, we initially applied closed reduction and circular casting in all the patients.…”