From the Guidelines
The operative procedure for distal radius fracture fixation with K-wires involves several key steps, including patient positioning, closed reduction, percutaneous K-wire insertion, and postoperative care, as outlined in the most recent and highest quality studies 1.
Key Steps in the Operative Procedure
- The patient is positioned supine with the affected arm on a radiolucent table under general or regional anesthesia.
- Closed reduction is performed by applying longitudinal traction and correcting the deformity under fluoroscopic guidance.
- Once acceptable reduction is achieved, K-wires (typically 1.6mm or 2.0mm) are inserted percutaneously, with the most common configuration involving two crossed K-wires from the radial styloid directed toward the ulnar cortex of the proximal radius.
- Additional K-wires may be placed from the dorsal-ulnar aspect of the distal radius for added stability if needed.
- Wire placement is confirmed with fluoroscopy in multiple views to ensure proper reduction and hardware position.
- The wires are then cut, bent, and left protruding through the skin for later removal.
- A well-padded short arm cast or splint is applied with the wrist in slight extension and ulnar deviation.
Postoperative Care
- Postoperatively, elevation and finger motion are encouraged, with K-wires typically removed in the office at 4-6 weeks when radiographic healing is evident.
- This technique is preferred for unstable extra-articular fractures or simple intra-articular fractures, particularly in patients with good bone quality, as it provides adequate stability while being minimally invasive with lower risk of soft tissue complications compared to plate fixation 1.
Indications for K-Wire Fixation
- The indication for fixation of distal radius fractures has been updated to reflect patients under the age of 65, with moderate support for operative fixation in the non-geriatric population and strong evidence that surgical fixation in those above 65 years of age does not lead to improved outcomes 1.
Importance of Patient-Centered Discussion
- A patient-centered discussion is crucial to inform appropriate decision-making, taking into account the individual patient's values, preferences, and functional demand, rather than relying solely on age as a proxy for functional demand 1.
From the Research
Operative Procedure for Distal End Radius Fracture using Kirschner Wire (K-wire)
The step-by-step operative procedure for a distal end radius fracture using Kirschner wire (K-wire) can be outlined as follows:
- Reduction of the fracture: The first step involves reducing the fracture to achieve anatomic alignment 2, 3.
- Percutaneous pinning: After reduction, percutaneous K-wire fixation is performed to stabilize the fracture 2, 4, 3.
- Pin-in-plaster technique: The K-wires are then secured with a cast, using the pin-in-plaster technique to maintain reduction during bone healing 2.
- Immobilization: The cast is used to immobilize the wrist and allow for bone union 2, 3.
- Follow-up: Regular follow-up is necessary to monitor the healing process and remove the K-wires and cast when appropriate 2, 4, 3.
Indications for K-wire Fixation
K-wire fixation is indicated for:
- Displaced extra-articular fractures 2
- Intra-articular fractures without significant comminution 2
- Articular step-off less than 2 mm 2
- Unstable fractures susceptible to re-dislocation 3
- Fractures classified as A2, A3, B1, C1, and C2 in the AO classification 5
Considerations
The choice of treatment approach depends on individual patient factors, including fracture geometry and patient-related variations 4, 5. The operating surgeon should evaluate the optimal treatment approach thoroughly, considering the patient's specific needs and conditions 4, 5.