The risks of Kirschner wire placement in the distal radius: a comparison of techniques

A comparison of percutaneous and limited open insertion of Kirschner wires (K-wires) in the distal radius was conducted in an effort to determine which technique has the lower rate of iatrogenic injury. Eighty-eight K-wires were inserted in the distal radii of 44 fresh cadaveric arms: 44 at Lister's tubercle and 44 at the tip of the radial styloid. No incision was used for the percutaneous technique. The limited open technique included a 1.5-cm incision with blunt dissection and use of a soft tissue protector. To define the incidence of nerve or tendon damage secondary to pin placement, the cadaveric wrists were subsequently dissected under 3.5x loupe magnification. The distances from the K-wires to the branches of the superficial radial nerve and to the first 3 extensor compartments were recorded. Structures pierced or displaced by a K-wire were considered potentially injured. Chi-square analysis demonstrated a significantly higher rate of potentially injured nerves and tendons in the percutaneous group. Thus, to reduce the risk of potential injuries, limited open incision, blunt dissection down to bone, and the use of a soft tissue protector for K-wire placement into the distal radius is recommended.