Is closed reduction of a fracture of the radius or ulna (Radius and Ulna) done with a K-wire (Kirschner wire)?

From the Guidelines

Closed reduction of fracture radius or ulna can be done with K-wires (Kirschner wires). K-wires are commonly used to stabilize fracture fragments after closed reduction, particularly in distal radius fractures. The procedure typically involves manipulating the fracture fragments back into anatomical alignment without surgically exposing the fracture site, followed by percutaneous insertion of K-wires through the skin to maintain the reduction. K-wires are thin, smooth, stainless steel pins that provide temporary fixation while the bone heals. They are especially useful for unstable fractures where casting alone would be insufficient to maintain proper alignment. The wires are usually left in place for 4-6 weeks, with the external portions protected by a cast or splint. This technique is preferred for many pediatric fractures and certain adult fractures because it is minimally invasive, preserves blood supply to the fracture fragments, and allows for adequate stabilization while healing occurs. After healing, K-wires are typically removed in an outpatient setting under local anesthesia or mild sedation.

According to the American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) clinical practice guideline summary management of distal radius fractures 1, the use of K-wires for closed reduction of fracture radius or ulna is a common practice. The guideline recommends the use of K-wires for the treatment of distal radius fractures, particularly in cases where closed reduction is not sufficient to maintain proper alignment.

Some key points to consider when using K-wires for closed reduction of fracture radius or ulna include:

• The procedure is minimally invasive and preserves blood supply to the fracture fragments
• K-wires provide temporary fixation while the bone heals
• The wires are usually left in place for 4-6 weeks, with the external portions protected by a cast or splint
• The technique is preferred for many pediatric fractures and certain adult fractures
• After healing, K-wires are typically removed in an outpatient setting under local anesthesia or mild sedation

It's worth noting that the evidence for the use of K-wires in closed reduction of fracture radius or ulna is based on a systematic review of the research related topic, which resulted in two recommendations classified as high, two recommendations classified as moderate, and two as limited 1. However, the most recent and highest quality study on this topic is the 2022 clinical practice guideline summary management of distal radius fractures 1, which provides the strongest evidence for the use of K-wires in this context.

From the Research

Closed Reduction Of Fracture Radius Or Ulna

• Closed reduction of fracture radius or ulna can be done with K-wire, as shown in several studies 2, 3, 4, 5, 6
• The Kapandji technique of K-wiring is widely practiced for distal radial fracture fixation in adults and can also be used in pediatric acute fractures 2
• Percutaneous pinning of distal radius fractures using K-wires is a reliable technique, but care must be taken to avoid injury to surrounding nerves and tendons 3
• Closed reduction using the percutaneous leverage technique and internal fixation with K-wires can be used to treat angulated radial neck fractures in children 4
• A novel method of closed reduction and percutaneous pinning with six K-wires has been developed for intra-articular fractures of the distal radius, showing excellent and good results in 87% of cases 5
• Percutaneous transphyseal intramedullary Kirschner wire pinning is a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children, with good functional results and no major complications 6

K-Wire Placement

• K-wires can be placed percutaneously into the distal radius or ulna to achieve reduction and fixation of the fracture 2, 3, 4, 5, 6
• The placement of K-wires should be done carefully to avoid injury to surrounding nerves and tendons, such as the superficial radial nerve and extensor tendons 3
• The use of multiple K-wires, such as six K-wires, can provide additional stability and support for the fracture 5

Clinical Outcomes

• The clinical outcomes of closed reduction and K-wire fixation for fracture radius or ulna are generally good, with high rates of excellent and good results 2, 4, 5, 6
• The use of K-wire fixation can allow for early mobilization and return to function, with most patients able to return to their original employment within 3 to 6 months 5