What are the operative steps for a distal radius fracture treated with a Kirschner wire (K-Wire)?

From the Guidelines

Distal radius fracture treatment with Kirschner wire (K-Wire) involves several operative steps.

Operative Steps

• The first step is to reduce the fracture under fluoroscopic guidance to ensure proper alignment of the bone fragments.
• Next, percutaneous pinning is performed using Kirschner wires to stabilize the fracture, as seen in the study by Hammer et al evaluating volar locked plating to external fixation augmented with Kirschner wires 1.
• The Kirschner wires are typically inserted percutaneously to minimize soft tissue damage and promote healing.
• Fluoroscopic guidance is used to confirm the correct placement of the Kirschner wires and to ensure that the fracture is properly aligned.
• The number and placement of Kirschner wires may vary depending on the specific fracture pattern and the surgeon's preference.
• Post-operative care includes immobilization of the wrist in a cast or splint, followed by a rehabilitation program to restore range of motion and strength to the wrist and hand. It's worth noting that, volar locked plates lead to earlier recovery of function in the short term (3 months) compared to other fixation techniques, including Kirschner wires 1. However, the choice of fixation technique depends on the specific fracture pattern, patient factors, and surgeon preference.

From the Research

Operative Steps for Distal Radius Fracture Treated with K-Wire

• The Kirschner wire (K-wire) fixation is mainly indicated in unstable types of Colles' and children's fractures of the distal radius 2
• The operative steps involve exposing the sensitive radial nerval paths, and 3-4 K-wires are inserted from the radial and the dorsoulnar aspect 2
• The K-wire ends are covered subcutaneously 2
• A modified technique that combines percutaneous pinning and casting can also be used, where percutaneous K-wire fixation and pin-in-plaster technique are employed 3
• The surgical indications of this technique included displaced extra-articular fracture, intra-articular fracture without significant comminution, and articular step-off less than 2 mm 3
• The use of K-wire fixation can provide adequate fixation, satisfactory radiological, and functional results for the management of distal radius fractures of various severities 4
• The operative treatment modality showed better functional end results, especially for intraarticular fractures, when compared to the conservatively treated fractures 5

Key Considerations

• The choice of treatment approach depends on individual features, and the choice for an internal fixation or closed reduction method for the restoration of wrist function should be evaluated thoroughly by the operating surgeon considering the patient-related variations 4
• Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting 6
• The clinical results correlate to the radiocarpal angle and radial shortening, and additional injuries to the ulnar complex can give worse results in reposition 2