[Radiological evaluation of k-wire osteosynthesis, in comparison to fixed-angle-plate osteosynthesis, in patients...

This study evaluates the short-term radiological outcome of K-wire osteosynthesis (KWO) in comparison to the fixed-angle-plate osteosynthesis (ORIF) on distal radius fractures in elderly patients (aged 80 years or more) with osteoporotic bones.

This study retrospectivly compares the postoperative X-rays of distal radius fractures (obtained between the years of 1998-2009) of patients aged 80 years and above treated with KWO (228 fractures, mean age 85 years), with the results of patients who were treated with fixed-angle plate ORIF (120 fractures, mean age 84 years). Within the KWO results, we also further compared the radiological results of a static and a dynamic (Kapandji) KWO technique. Only patients with a postoperative, anatomic reduction, and those who were radiologically followed up in a period of 2 months and above were included. The radiological criteria included the palmar and radial inclination as well as the radial shortening.

With KWO performed in a static technique, 24% of the postoperative results showed no reduction loss. The use of the dynamic Kapandji technique KWO, improved the positive results to 63%. However, almost a third of the fractures (30%) treated with KWO, had shifted back to their preoperative positions, or worsened overall. The fixed angle plate (ORIF) was able to maintain 76% of all fractures in their postoperative positions. Merely 1.7% of the ORIF group sustained a complete reduction loss. The fixed-angle plate osteosynthesis shows a significant decrease of cases in which a complete repositioning loss is experienced.

Although the importance of anatomic reconstruction of distal radius fractures is often debated in cases involving elderly patients, it is our considered opinion that, should an operative solution be chosen, one should consider the fixed-angle-plate osteosynthesis as the preferred operation method to prevent loss of reduction.