A comparative study of volar plate fixation versus percutaneous Kirschner wire fixation in the management of distal radius fracture in adults

Author(s): Dr. Pappu Marandi and Dr. Rahul Kumar Chandan

Abstract: Fracture distal radius is the most common fracture approximately 25% of all fractures treated at an emergency department, which constitutes 17% of all fractures and 75% of all forearm fractures. Conventional method of reduction and cast treatment for distal radius fracture has resulted in unsatisfactory anatomical and functional results, varying degrees of deformity and disability with secondary loss of reduction during ongoing treatment. Fixed angle volar plating and k wiring represents a valuable treatment modality for the most frequent types of unstable fractures of the distal radius. Patients admitted were randomly assigned to either k wiring group (Group A) or Volar plating group (Group B).In group A, percutaneous k wiring done after closed reduction under image intensifier whereas in group B, volar plating done after open reduction through modified Henry approach. All the patients were regularly followed up. Functional outcome is determined on the basis of disability arm, shoulder and hand score (DASH). The overall mean age of the patients was 44.5±11.94 years. The age group 41-50 years comprised the highest number of patients (37.09%). AO Type A fracture constituted the highest number of patients (45.2%) followed by type C fractures (37.1%).The mean time to operation from the date since injury for all fractures was 5.09±2.82 days. The duration taken for surgery for k wire group was 20.194.88 days and for volar plate group was 49.83±7.0 days. The average blood loss was higher for volar plating group. For k wire group average blood loss was 8.09±3.59ml and for volar plate was 155.48±18.76ml.Duration of fracture union in k wire group and volar plate group was seen by 7.38±1.02 and 6.67±0.83 weeks respectively. The mean DASH score at the end of follow up was 6.03±1.87 for volar plate group and 7.00±2.38 for the k wire group. At 12 weeks from the procedure, clinical results seem to favour patients treated with plating, but there were no significant difference between the two types of treatment at long term follow up. Unstable intra-articular radius fractures that cannot be reduced or held reduced with pinning should be treated with locking volar plate, however k wiring remains a simple and inexpensive option for simple fracture patterns.

DOI: https://doi.org/10.22271/ortho.2019.v5.i4j.1733