Radius Distal End Fractures: A Prospective Randomized Comparison of Intrafocal (Kapandji) Pinning Versus External Fixaton

Öz

Objective: The aim of this study was to compare intrafocal wire (Kapandji) and external fixation techniques, to evaluate the quality of the reduction, functional outcomes and the subjective opinions in dorsally displaced fractures of the distal radius.
Materials and Meyhods: Regardless of age, 101 closed dorsally displaced distal radius fractures, except those with multiple intraar-ticular fracture line, were included in this study. 46 of them were treated with Kapandji and 55 with external fixator.
Results: At post-op 3rd week, pain was more evident (p=0,049) in patients treated with Kapandji method. The range of motion, except for the patients with ulnar deviation, was better in patients treated with Kapandji at 6 weeks (flexion p<0,001, extension p<0,001). Regardless of surgical technique, intraarticular fractures do not affect functional progression (ROM, grip strength, daily activities). The results were similar at 6 months. The recovery of grip strength was better for intrafocal pinning at 6 weeks (p=0,000) and 3 months (p=0,011).
Conclusion: The results obtained with both techniques are similar. In our opinion, the consolidation period lasts longer than expected. It might be better to increase the immobilization time and delay the removal of the wires. In addition, bone grafting can be a solution to improve radiological outcomes for fractures with severe dorsal comminution.

Radius Distal Uç Kırıkları: Kapandji Yöntemiyle İntrafokal Telleme ve Eksternal Fiksatör Tekniklerinin Prospektif Randomize Bir Çalışma ile Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı, radius distal uç kırıklarında, intrafo-kal telleme (Kapandji) ve eksternal fiksatör (EF) tekniklerini, karşı-laştırmak, radyolojik olarak redüksiyon’un kalitesi, fonksiyonel sonuçlar ve hastanın subjektif görüşlerini değerlendirmektir.
Materyal ve Metod: Yaş göz önüne alınmadan, birden fazla eklem içi kırık hattı olan çok parçalı kırıklar hariç, dorsale yer değiştirmiş radius distal uç kapalı kırığı ile başvuran 101 hasta değerlendirmeye alındı. 46 tanesi Kapandji, 55 tanesi EF ile tedavi edildiler.
Bulgular: Post-op 3. haftada, Kapandji yöntemiyle tedavi edilen hastalarda ağrı daha belirgindi (p=0,049). Hareket sınırları, ulnar deviasyon hariç, 6. haftada Kapandji yöntemiyle tedavi edilenlerde daha iyidi (fleksiyon için p<0,001, ekstansiyon için p<0,001). Eklem içi kırıkların, cerrahi teknik göz önüne alınmadan, fonksi-yonel ilerleme (Hareket açıklığı, el sıkma kuvveti, günlük aktivite) üzerine etki etmediği görüldü. Sonuçlar 6. ayda benzer bulundu. El sıkma kuvvetinin geri kazanılması intrafokal telleme için 6. hafta (p=0,000) ve 3. Ayda (p=0,011) daha iyiydi.
Sonuç: Her iki teknik ile elde edilen sonuçlar birbirine benzerdir. Bizce konsolidasyon süresi düşünülenden daha uzun sürmektedir. Acaba immobilizasyon süresinin biraz daha arttırılması veya telle-rin çıkarılmasının geciktirilmesi gerekmez mi? Ayrıca, kemik grefti, önemli dorsal çok parçalanma olan kırıklarda radyolojik sonuçları iyileştirecek bir çözüm olabilir.

Anahtar Kelimeler

• Radius distal uç,eksternal fiksatör,Kapandji,kırık

Kaynakça

1. 1. Pogue DJ, Viegas SF, Patterson RM, et al. Effects of distal radius fracture malunion on wrist joint mecha-nics. J Hand Surg Am. 1990;15(5):721-727.
2. 2. Baumer A, McQueen MM. Fractures of the distal radius in low-demand elderly patients: closed reduc-tion of no value in 53 of 60 wrists. Acta Orthop Scand. 2003;74(1):98-100.
3. 3. Jupiter JB. Fractures of distal end of radius. J Bone Joint Surg Am. 1991;73(3):461-469.
4. 4. Kapandji A. Ostéosynthèse par double embrochage intrafocal. Traitement fonctionnel des fractures non articulaires de l’extrémité inférieure du radius. Ann Chir. 1976;30(11- 12):903-908.
5. 5. Slutsky DJ. External fixation of distal radius fractu-res. J Hand Surg Am. 2007;32:1624-37
6. 6. Mirhamidi SM, Bayat FM. A prospective comparison between Kapandji and percutaneous extra-focal fixation in extraarticular distal radius fractures. Int J Clin Exp Med. 2013;6(2):133-139.
7. 7. Trumble TE, Wagner W, Hanel DP, Vedder NB, Gil-bert M. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg.1998;23(3):381-394.
8. 8. Kaempffe FA, Wheeler DR, Peimer CA, Hvisdak KS, Ceravolo J, Senall J. Severe fractures of the distal ra-dius: effect of amount and duration of external fixa-tor distraction on outcome. J Hand Surg. 1993;18(1):33-41.

9. 9. Castaing J. Les fractures récentes de l’extrémité inférieure du radius chez l’adulte. Rev Chir Orthop. 1964;50:581-696.
10. 10. Maffulli N, Fixsen JA. Painful hypertrophic non-union of the unlar styloid. J Hand Surg Br. 1990;15(3):355-357.
11. 11. Tsukazaki T, Iwasaki K. Ulnar wrist pain after Col-les’ fracture. Acta Orthop Scand. 1993 64(4):462-464.
12. 12. Bisaccia M, Rinonapoli G, Bisaccia O. Articular frac-tures of distal radius: Comparison of treatment and clinical and radiological outcomes with volar plate versus Hoffmann bridging external fixator. Eurome-diterranean Biomedical Journal. 2017;12(6):23-28.
13. 13. Delattre O, Saillant G, J Lemoine, Benazet JP, Roy-Camille R. Reduction and osteosynthesis with pin fixation of wrist fractures. A comparative study between Kapandji’s and Py’s techniques. Rev Chir Orthop. 1994;80(2):94-107.
14. 14. Docquier J, Soete P, Twahirwa J, Flament A. Ka-pandji’s method of intrafocal nailing in Pouteau-Colles fractures. Acta Orthop Belg. 1982;48(5):794-810.
15. 15. Vaughan PA, Lui SM, Harrington IJ. Treatment of unstable fractures of the distal radius by external fixation. J Bone Jt Surg Br. 1985;67(3):385-389.
16. 16. Cooney WP, Linscheid RL, Dobyns JH. External pin fixation for unstable Colles’ fractures. J Bone Joint Surg Am. 1979;61(6A):840-845.
17. 17. Milliez PY, Auquit-Auckbur I, Thomine JM. Fixation externe des fractures comminutives du radius distal. Cahier d’enseignement de la SOFCOT. Expansion Scientifique Publications, Paris. 1998:169-176.
18. 18. Leung KS, Shen WY, Tsang HK, Chiu HK, Leung PC, Hung LK. An effective treatment of comminuted fractures of the distal radius. J Hand Surg Am. 1990;15(1):11-17.
19. 19. Edwards G. Intra-articular fractures of the distal part of the radius treated with the small AO external fixa-tor. J Bone Joint Surg Am. 1991;73(8):1241-1250.
20. 20. Cooney WP, Dobyns JH, Lınscheid RL. Complicati-ons of Colles’ fractures. J Bone Joint Surg Am. 1980;62(4):613-619.
21. 21. Jakim I, Pieterse HS, Sweet MBE. External fixation for intra-articular fractures of the distal radius. J Bo-ne Joint Surg Br. 1991;73(2):302-306.
22. 22. Jupiter JB, Lipton H. The operative treatment of ıntraarticular fractures of the distal radius. Clin Ort-hop Relat Res. 1993;292:48-61.
23. 23. Herrera M, Chapman CB, Roh M, Strauch RJ, Ro-senwasser MP. Treatment of unstable distal radius fractures with cancellous allograft and external fixa-tion. J Hand Surg Am. 1999;24(6):1269-1278.
24. 24. Saddiki R, Ohl X, Hemery X, Vitry F, Dehoux E, Harisboure A. Dorsally displaced distal radius fractu-res : comparative study of Py’s and Kapandji’s tech-niques. Orthop Traumatol Surg Res. 2012;98(1):61-67.
25. 25. Neto AP, Lhamby FC. Fixation of fractures of the distal extremity of the radius using the modified Ka-pandji technique: Evaluation of the radiological re-sults. Rev Bras Ortop. 2015;46(4):368-373.
26. 26. Shukla R, Jain RK, Sharma NK, Kumar R. External fixation versus volar locking plate for displaced intra-articular distal radius fracture: a prospective rando-mized comparative study of the functional outco-mes. J Orthop Traumatol. 2014;15(4):265-70.
27. 27. Wilcke MK, Abbaszadegan H, Adolphson PY. Wrist function recovers more rapidly after volar locked plating than after external fixation but the outcomes are similar after 1 year. Acta Orthop. 2011;82(1):76-81.
28. 28. Krukhaug Y, Ugland S, Lie SA, Hove LM. External fixation of fractures of the distal radius: a randomi-zed comparison of the Hoffman compact II non-bridging fixator and the Dynawrist fixator in 75 pati-ents followed for 1 year. Acta Orthop. 2009;80(1):104-108.
29. 29. Chilakamary VK, Lakkireddy M, Koppolu KK, Ra-pur S. Osteosynthesis in distal radius fractures with conventional bridging external fixator; tips and tricks for getting them right. J Clin Diagn Res. 2016;10(1):RC05-8.
30. 30. Atkins RM, Duckworth T, Kanis JA. Algodystrophy following Colles’ fracture. J Hand Surg Br. 1989;14(2):161-164.