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Displaced distal end radius fractures in children treated with Kirschner wires - A systematic review
Insights
Kirschner wire fixation is a common treatment for pediatric distal radius fractures. This review found specific indications, techniques, and immobilization methods, with low re-displacement rates but a need for more research.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Kirschner wire (K wire) fixation is frequently used for pediatric distal radius fractures.
- However, clear guidelines regarding indications, techniques, immobilization, and complications are lacking.
Purpose of the Study:
- To systematically review the current literature on Kirschner wiring for pediatric distal radius fractures.
- To identify common indications, techniques, immobilization methods, and complications.
Main Methods:
- A systematic literature search was conducted, identifying 4263 articles.
- Full-text review of 78 articles was performed, with 14 ultimately included in the analysis.
Main Results:
- Complete displacement and >50% translation are common indications for K wire fixation.
- The most frequent technique involves two retrograde wires (non-Kapandji fashion).
- Long arm casts are the preferred immobilization method, and superficial infection is the most common complication, with low re-displacement rates.
Conclusions:
- Kirschner wiring for pediatric distal radius fractures has established indications and techniques, with favorable outcomes regarding re-displacement.
- The current evidence base is largely retrospective, highlighting the need for multicenter randomized controlled trials to establish definitive management protocols.
Abstract:
The indications for Kirschner wiring, the technique of wiring, type of cast immobilization, period of immobilization and complications of K wires are unclear. We conducted a systematic review of the literature on Kirschner wiring of distal radius fractures in children. A total of 4263 articles were identified. The full text of the remaining 78 articles was reviewed. 64 articles were finally excluded because of incomplete data leaving 14 for analysis. Complete fracture displacement and translation more than 50% are the commonest indications for Kirschner wiring of these fractures with 2 retrograde wires in non-Kapandji fashion being the commonest technique. Long arm casts are the favored modality of immobilization with superficial infection being the commonest complication. Re-displacement rates are low after Kirschner wiring. Most studies were retrospective and there is the need for a multicenter randomized controlled trial to define protocols for management of displaced distal radius fractures in children.
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