Modified Kapandji technique in pediatric displaced distal radius fractures: results in 195 patients
Cristina Bassi1, Alexander F Heimann2, Joseph M Schwab1
1Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland.
Insights
The modified Kapandji technique effectively reduces pediatric displaced distal radius fractures (DDRFs) with good to anatomical outcomes in 85% of cases. Complications requiring further surgery are rare, making it a safe treatment option.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Fracture management
Background:
- The modified Kapandji technique is a proposed method for reducing pediatric displaced distal radius fractures (DDRFs).
- Limited evidence currently exists regarding its efficacy and safety.
- This study aims to systematically evaluate outcomes and complications associated with this technique.
Purpose of the Study:
- To assess the quality of fracture reduction achieved with the modified Kapandji technique in pediatric DDRFs.
- To evaluate the stability of fracture alignment post-treatment.
- To determine the incidence and severity of postoperative complications.
Main Methods:
- A retrospective observational study included 195 pediatric patients treated with the modified Kapandji technique.
- Fracture reduction quality, fixation type (intrafocal, combined, extrafocal), and angulation were assessed.
- Patients were stratified by fracture type, fixation, and age group.
Main Results:
- Good to anatomical fracture reduction was achieved in 85% of patients.
- Metaphyseal fractures had less frequent anatomical reduction and higher angulation changes.
- An overall complication rate of 15% was observed, with only 1% being severe (modified Sink Grade 3).
Conclusions:
- The modified Kapandji technique is a safe and effective treatment for pediatric DDRFs.
- Extrafocal or combined wire fixation is recommended for non-physeal metaphyseal fractures.
- Significant complications necessitating further surgical intervention are infrequent.
Purpose:
The modified Kapandji technique has been proposed for fracture reduction in pediatric displaced distal radius fractures (DDRFs), but evidence is sparse. The purpose of this study was to evaluate our outcomes and complications, critically and systematically, when performing the modified Kapandji technique in pediatric DDRFs. Using this technique since 2011, we asked: (1) What is the quality of fracture reduction using this technique? (2) How stable is fracture alignment with this technique? (3) What are the postoperative complications and complication rates?
Methods:
Retrospective observational study of 195 pediatric patients treated with the modified Kapandji technique. Quality of fracture reduction, fixation type (intrafocal, combined, or extrafocal), and coronal/sagittal angulation were recorded at surgery and healing. Perioperative complications were graded. Patients were stratified by fracture (metaphyseal or Salter-Harris) and fixation type, as well as age (≤ 6 years; 6 to 10 years; > 10 years).
Results:
Fracture reduction was 'good' to 'anatomical' in 85% of patients. 'Anatomical' fracture reduction was less frequent in metaphyseal fractures (21% vs. 51%; p < .001). Mean angulation change was higher in metaphyseal fractures in both the sagittal (p = .011) and coronal (p = .021) planes. Metaphyseal fractures showed a higher mean change in sagittal angulation during fracture healing for the 'intrafocal' group. We observed a 15% overall complication rate with 1% being modified Sink Grade 3.
Conclusion:
The modified Kapandji technique for pediatric DDRFs is a safe and effective treatment option. Metaphyseal fractures that do not involve the physis should be treated with extrafocal or combined wire fixation. Complications that require additional surgical treatment are rare.
Level Of Evidence:
Level of evidence IV.
