Observation on the therapeutic effect of manual reduction and percutaneous K-wire treatment for unstable distal radius fractures in the elderly patients

Tan Dan; Zhou Yong; Zhan Xiaobo; Bao Quanwei

doi:10.3969/j.issn.1002-1949.2024.10.004

Abstract：Objective To explore the surgical method and clinical efficacy of manual reduction and percutaneous K-wire fixation for unstable distal radius fractures in the elderly patients.Methods A retrospective analysis was conducted on 45 elderly patients with unstable distal radius fractures treated with manual reduction and percutaneous K-wire fixation from December 2022 to October 2023 in Emergency Medicine department of the Second Hospital Affiliated to Army Medical University,and another 45 elderly patients with unstable distal radius fractures receiving open reduction and plate internal fixation were treated as the control group at the same time.The surgical method involved manual traction reduction of distal radius fractures under brachial plexus anesthesia;under C-arm fluoroscopy,a K-wire was inserted percutaneously from the distal end of the ulna,passed through the distal radioulnar joint along the subchondral bone to lock the distal radius to maintain the height and palmar inclination angle of the distal radius,then a K-wire was inserted percutaneously from the styloid process side of the distal radius to maintain the radial deviation angle of the distal radius,and finally a K-wire could be inserted percutaneously from the dorsal side of the distal radius to pry and fix the comminuted fracture fragments;finally,the tail end of the K-wire was cut and buried under the skin,and the patients were followed up regularly,with the K-wire removed as appropriate at 6-8 weeks postoperatively.The control group was treated by the conventional Henry approach with direct view reduction and distal radius plate fixation.The healing of the fracture,the recovery of function and complications were observed in the two groups.Results The average time of fracture healing was 3.8(3,5)months.Compared with the patients treated with open reduction and plate internal fixation at the early stage,the hospitalization costs of the patients treated with manual reduction and K-wire internal fixation were significantly reduced(yuan:34 179.70±4 000.00 vs.4 220.56±500.00,P＜0.01),and the hospital stay was significantly shortened(d:7.2±1.5 vs.1.2±0.2,P＜0.01);at the 4-month follow-up postoperatively,there was no significant difference in the Gartland-Werley score for wrist joint function(95.6％vs.97.8％,P＞0.05),and there was also no significant difference in the quick DASH score(scores:9.89±3.43 vs.9.64±3.36,P＞0.05).Conclusions The elderly patients with unstable distal radius fractures achieve secondary stability by manual reduction and K-wire fixation of the distal radioulnar joint,the use of K-wire fixation is a simple,cost-effective and effective method,which is worth promoting and applying.