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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 9-11

Comprehensive–Comparative study of fracture distal end radius with plating and K-Wire fixation


1 PG Student, Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India
2 Professor and Head, Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India
3 Assistand Professor, Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India

Date of Submission20-Nov-2020
Date of Decision12-Dec-2020
Date of Acceptance11-Feb-2021
Date of Web Publication26-Apr-2021

Correspondence Address:
Ashutosh Kumar
Department of Orthopaedics, Darbhanga Medical College and Hospital, Darbhanga, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jodp.jodp_34_20

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  Abstract 


Introduction: Distal end radius fracture is a common fracture seen in the routine orthopedic outpatient department. The optimal management of distal radius fractures remains controversial. Aim: The aim of the study is to compare the functional outcomes folloing volar plating and K-ire fixation of the distal end radius fractures and to compare hich method produced better result. The functional outcome in terms of range of movements, pain, and grip strength of the patients as assessed at 6 months in both groups by demerit score system of Gartland and Werley. Material and Methods: The ORIF group as treated ith volar plating and CRIF group ith k ires. The functional outcome as measured using Gartland and Werley system. Results: Functional outcome as per Gartland and Werley as 95% excellent-to-good results in the plating group as compared to 75% in the K-ire fixation group. Conclusion: The study emphasizes that open reduction and internal fixation ith volar plating has excellent functional outcome hen compared to K-ire fixation in distal radius fractures. When considering the cost, K-ire fixation is preferred over volar plating.

Keywords: Distal radius fracture, fixation, K-ire, volar plating


How to cite this article:
Kumar R, Kumar N, Kumar A. Comprehensive–Comparative study of fracture distal end radius with plating and K-Wire fixation. J Orthop Dis Traumatol 2021;4:9-11

How to cite this URL:
Kumar R, Kumar N, Kumar A. Comprehensive–Comparative study of fracture distal end radius with plating and K-Wire fixation. J Orthop Dis Traumatol [serial online] 2021 [cited 2021 Nov 27];4:9-11. Available from: https://www.jodt.org/text.asp?2021/4/1/9/314642




  Introduction Top


Fractures of the distal radius are the most common fractures of all. 30% of the patients treated in the emergency centers have an injury to the rist, and majority of them have distal radius fractures.[1] Abraham Colle of Dublin, Ireland, in 1814 as the first to describe hat is no commonly knon as Colles' fracture; he had described it as a fracture involving distal corticocancellous junction of the radius ith classical deformity.[2],[3] Management protocols for these fractures have undergone significant advancement over the preceding years. These can be treated conservatively using closed reduction and immobilization in a plaster cast, hich may lead to early displacement; hence, skeletal fixation to maintain the reduction has been recommended.[4],[5] Methods such as external fixation used for ligamentotaxis, percutaneous fixation ith K-ires or plate osteosynthesis, or combination of all the above have been advocated to achieve adequate reduction and fixation of displaced distal radius fractures. [6,7]

Aims and objectives

The aim and objective of the study are to compare functional outcomes folloing volar plating and K-ire fixation of the distal end radius fractures and to compare hich method produced better outcomes.


  Materials and Methods Top


An observational study as done at the Department of Orthopaedics, in Darbhanga Medical College and Hospital, Darbhanga. The duration of the study as from July 2018 to August 2020. All patients ith radiologically confirmed fractures of the distal end radius ere included in the study. We excluded undisplaced fractures, those ho have not attained skeletal maturity, and open fractures of the distal radius associated ith neurovascular deficit. All patients ho satisfied the inclusion and exclusion criteria during the study period ere included in the study until the sample size as attained. The patients ere allocated into to groups of 20 patients each. One group as treated by open reduction and volar plating (Group A), and the other group as treated by closed reduction percutaneous K-ire fixation and cast application (Group B).

Outcome measurements

The functional outcome in terms of range of movements, pain, and grip strength of the patients as assessed at 6 months in both groups by single author AK. Demerit score system of Gartland and Werley. The range of movement of the rist and forearm as measured using a goniometer. Grip strength as assessed by a dynamometer. The intensity of pain as recorded on a visual analog scale from 1 to 10.

Method of collection

All patients ho attend the outpatient/casualty of Orthopaedic Department at Darbhanga Medical College, Bihar, during stipulated time period, having the distal end radius fracture ere included in the study. All fractures ere classified according to Fernandez classification, and only Type 2 and 3 fracture patterns ere included in the study [Table 1]. Functional assessment as done at 6 months ith the help of Gartland and Werley score system. Conclusions ere dran at the end of the study. After obtaining ethical clearance from the institutional ethics committee, the study as conducted among the study populations after obtaining ritten informed consent. Group A as operated through volar approach, under tourniquet control and the use of a volar T-plate. Group B as treated by closed reduction and K-ire fixation [Figure 1]. Similar plaster splints, antibiotic (cephalosporin), and analgesic regimens ere used in both groups. Stitches ere removed in Group A after 10 days, and a gentle physiotherapy plan as instituted. K-ires ere removed at 5–6 eeks in the other group and cast continued for 2 more eeks. A similar rehabilitation program consisting of assisted and active range of motion exercises as done in both the groups for 3 months.
Table 1: Age incidence

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Figure 1: Closed reduction and K-wire fixation

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  Results Top


The present study consists of 20 cases of distal radial fractures treated: 12 cases ere closed fractures hile 8 cases ere open fractures. Most of the patients ere in younger age group, 21 to 30 years and 31 to 40 years. This group comprised the 50% of the total study [Table 1]. Males ere commonly affected [Table 2]. Right being the dominant side affected commonly [Table 3]. Mechanism of Trauma as same in both groups of RTA and Fall. [Table 4]. Extraarticular fractures ere more common [Table 5]. Percutaneous K ire fixation as done in most of the cases [Table 6].
Table 2: Sex incidence

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Table 3: Side of involvement

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Table 4: Mode of injury

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Table 5: Extra-articular and intra-articular fracture

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Table 6: Type of fixation

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Functional assessment of rist as done by Gartland and Werley score.


  Discussion Top


The fractures of the distal end of the radius, despite being the most common upper extremity fractures, continue to pose a therapeutic challenge. The aim is to regain the normal range of movements and anatomical integrity ithout pain. Treatment modalities have undergone significant advancements due to improved imaging techniques, hich have provided a better understanding of fractures and explained the effects of the different injury types on fracture formation and factors that lead to instability. Kiernan in his study compared radiological outcomes in those treated ith volar locking plate to those undergoing manipulation and K-ire fixation in the 20–65 years population. According to him, volar plating has superior advantage hen compared ith K-ire fixation. Beharrie et al., in 2004, published a study comparing these to methods. They shoed a clear advantage of K-ire fixation over T-plate method.


  Conclusion Top


The study emphasizes that open reduction and internal fixation ith volar plating has better functional outcome here there is significant intra-articular displacement hile K-ire fixation is better in extra-articular fracture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Johnson NA, Dias JJ, Wildin CJ, Cutler L, Bhoal B, Ullah AS. Comparison of distal radius fracture intra-articular step reduction ith volar locking plates and K ires: A retrospective revie of quality and maintenance of fracture reduction. J Hand Surg Eur Vol 2017;42:144-50.  Back to cited text no. 1
    
2.
Rizzo M, Katt BA, Carothers JT. Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures. Hand (N Y) 2008;3:111-7.  Back to cited text no. 2
    
3.
Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th ed., Vol. 4. St. Louis, MO, London: Mosby; 2012. p. 4664.  Back to cited text no. 3
    
4.
Khan SM. Volar Plating in Distal End Radius Fractures and Its Clinical and Radiological Outcome as Compared to other Methods of Treatment. Available from: http//. joas.in/article.asp?issn =2319-2585;year=2016;volume=4;issue=1;spage=40;epage=44;au last=Khan. [Last accessed on 2018 Mar 23].  Back to cited text no. 4
    
5.
Bucholz RW, Court-Bron CM, Heckman JD, Tornetta P, editors. Rockood and Green's Fractures in Adults: To Volumes Plus Integrated Content Website. 7th ed. Philadelphia, PA: Wolters Kluer; 2009. p. 2296.  Back to cited text no. 5
    
6.
Brennan SA, Kiernan C, Beecher S, O'Reilly RT, Devitt BM, Kearns SR, et al. Volar plate versus k-ire fixation of distal radius fractures. Injury 2016;47:372-6.  Back to cited text no. 6
    
7.
Changulani M, Okonko U, Kesani T, Kalairajah Y. Outcome evaluation measures for rist and hand – Which one to choose? Int Orthop 2008;32:1-6.  Back to cited text no. 7
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Abstract
Introduction
Materials and Me...
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