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The Journal of Bone and Joint Surgery (American). 2004;86:2621-2628
© 2004 The Journal of Bone and Joint Surgery, Inc.

Two Procedures for Kirschner Wire Osteosynthesis of Distal Radial Fractures

A RANDOMIZED TRIAL

P.C. Strohm, MD,1, C.A. Müller, MD, PhD1, T. Boll, MD2 and U. Pfister, MD, PhD2

1 Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Klinik für Traumatologie, Hugstetterstrasse 55, 79106 Freiburg im Breisgau, Germany. E-mail address for P.C. Strohm: strohm{at}ch11.ukl.uni-freiburg.de
2 Städtisches Klinikum Karlsruhe, Klinik für Unfall-, Handund Wiederherstellungschirurgie, Moltkestrasse 90, 76133 Karlsruhe, Germany

Investigation performed at Städtisches Klinikum Karlsruhe, Klinik für Unfall-, Handund Wiederherstellungschirurgie, Karlsruhe, Germany

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The treatment of displaced Colles-type fractures of the distal part of the radius remains a challenge. Two procedures for closed reduction and Kirschner wire osteosynthesis of these fractures were compared in a prospective randomized study.

Methods: One hundred consecutive patients with a Colles fracture of the distal part of the radius (AO classification 23-A2, 23-A3, or 23-C1) were treated over an eighteen-month period. One group was managed with the conventional method, described by Willenegger and Guggenbühl in 1959, in which two Kirschner wires are introduced into the styloid process of the radius. The other group was treated with the Kapandji method, as modified by Fritz et al., in which two Kirschner wires are inserted into the fracture gap and a third is placed through the styloid process. Postoperative care was standardized for both groups and carried out according to a strict procedure. Forty patients who had been operated on according to the modified Kapandji method and forty-one treated with the Willenegger technique were available for follow-up, for a follow-up rate of 81%. The follow-up assessment was performed with a modified version of the Martini score.

Results: The median time to follow-up was ten months (range, six to twenty months). The results as assessed with the Martini score were, on the average, good to very good for the patients treated with the Kapandji method and satisfactory to good for the patients treated with the conventional Kirschner wire fixation. The duration of radiographic exposure was significantly shorter with the Kapandji method than with the Willenegger technique.

Conclusions: Conventional Kirschner wire fixation remains a good method of osteosynthesis for the treatment of displaced fractures of the distal part of the radius. We found both the functional and radiographic outcomes of the Kapandji method to be significantly better than those of the Willenegger technique.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.


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