Trans-styloid fixation of fractures of the distal radius: A prospective randomized comparison between 6- and 1 -week postoperative immobilization in 60 fractures

Abstract

We performed a prospective randomized study on 60 patients with dorsally displaced extra-articular or noncomminuted intraarticular fractures of the distal radius. All 60 fractures were treated by closed reduction and Kirchner wire trans-styloid fixation. 30 patients had 1 weeks' postoperative immobilization and 30 patients had 6 weeks' immobilization. All patients had a clinical and radiographic review at 6 weeks and at 1 year after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, frontal radial deviation, ulnar variance, and radial shortening were assessed radiographically. Rates of complications were the same in both groups. At follow-up, pain was similar in both groups and range of motion and grip strength were somewhat better after early mobilization--in comparison with the opposite wrist--but this was statistically significant only for ulnar deviation. The postoperative radiographic reductions were similar in both groups, with no differences in loss of reduction after bone healing. Therefore, in Colles' fractures, trans-styloid fixation with two K-wires seems to give a stable osteosynthesis, which does not need additional immobilization with a plaster cast.

Which modality is the best choice in distal radius fractures treated with two different Kirschner wire fixation and immobilization techniques?

“…[24,28] In two trials testing the duration of immobilization after surgery, no statistically significant difference was found in functional and radiological results. [29,30] The method of limb immobilization following pinning is considered controversial among authors studying this topic. [2,31,32] To the best of our knowledge, there has been no previous report in the English literature of an immobilization method as described here for Group I patients of this study.…”

Common Myths and Evidence in the Management of Distal Radius Fractures

“…Early wrist mobilization after internal fixation is safe, but it does not improve final arc of motion, grip strength, pain, DASH score or radiographic measurements. 55, 56 …”

An Anatomical Study to Demonstrate the Proximity of Kirschner Wires to Structures at Risk in Percutaneous Pinning of Distal Radius Fractures

“…The branches of various nerves, including superficial branch of radial nerve (SRN) [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18], lateral cutaneous nerve of forearm (LCNFA) [7,10,12], dorsal branch of ulnar nerve (DBUN) [9], the radial artery [5,10,12] and cephalic vein [10,12], and the extensor tendons [6,11,15,19,20] (dorsal wrist extensor compartments EI to EV) are at risk of injury during this procedure. Injury to the superficial nerves could lead to formation of painful neuromas and precipitate the dreaded complication of reflex sympathetic dystrophy [3,15]. Injury to the radial artery could lead to acute ischemia of the hand leading to gangrene especially when the palmar arch is incomplete.…”

“…According to Singh et al [18] the incidence of superficial nerve injury in radial styloid pinning may be as high as 20 %. Most studies advocate making a stab incision and carefully retracting the soft-tissues out of harm's way while inserting K-wires percutaneously [5,6,8,9,11,13,15,[19][20][21]. However, in practice, it is often seen that K-wires are shoved in blindly through intact skin while performing percutaneous pinning [2,6,13].…”