Variables affecting stability of distal radial fractures fixed with K wires: A radiological study

  • Harish V. KurupEmail author
  • Vipul Mandalia
  • B. Singh
  • K. A. Shaju
  • R. L. Mehta
  • A. R. Beaumont
Original Article


The aim of this retrospective study was to identify the variables associated with poor radiological outcome in distal radial fractures stabilized with K wires. Patients who underwent K-wire fixation for unstable fractures of the distal radius in the last 3 years were included. Fractures were classified according to AO classification. Immediate postfixation radiographs and radiographs taken just prior to removal of K wires were analyzed to study three radiological parameters: palmar or dorsal tilt, radial inclination, and ulnar variance. Changes in these parameters were used to grade the anatomical end result as excellent, good, fair, or poor according to the Stewart classification. The results were analyzed statistically against variables such as age, gender, AO classification, associated ulnar fracture, number of K wires used, delay in fixation, and duration of fixation. A total of 113 fractures were analyzed. Average age of patients was 56.2 years, with male-to-female ratio of 1:2. Average loss of radial tilt was 4.12°, loss of palmar tilt was 8.07°, and loss of ulnar variance was 3.12 mm. We found excellent results in 23.9%, good result in 56.6%, fair results in 15%, and poor results in 4.4% of patients. Age more than 65 years (P value 0.004), significant comminution (A3 or C3 in AO classification) (P value 0.007), and associated ulnar fracture (P value 0.015) were the variables found to have statistically significant correlation with poor radiological outcome.


Distal radius fracture K-wire fixation Stability Radiological variables 

Variables affectant la stabilité des fractures distales du radius embrochées


Le but de cette étude était d’identifier les variables liées aux pauvres résultats radiologiques dans les fractures distales du radius stabilisées avec des broches de Kirschner (K). Des patients ayant bénéficié de cette technique pour des fractures distales instables du radius durant les trois dernières années ont été inclus dans cette étude rétrospective. Les fractures ont été classifiées selon la classification AO. Des radiographies post-opératoires précoces et des radiographies prises juste avant l’ablation des broches de K ont été analysées pour étudier trois paramètres radiologiques (inclinaison palmaire ou inclinaison dorsale, inclinaison radiale et décalage ulnaire). Les changements de ces paramètres ont été employés pour évaluer le résultat final anatomique comme excellent, bon, moyen ou mauvais selon la classification de Stewart. Les résultats ont été analysés statistiquement pour des variables comme l’âge, le sexe, la classification AO, la fracture ulnaire associée, le nombre de broches de K utilisées, le délai de consolidation et la durée de la fixation. Un total de 113 fractures a été analysé. L’âge moyen des patients était de 56.2 ans avec un ratio hommes/femmes de 1:2. La perte moyenne d’inclinaison radiale était de 4.12 degrés, la perte d’inclinaison palmaire était de 8.07 degrés et la perte de décalage ulnaire était de 3.12 millimètres. Nous avons trouvé d’excellents résultats dans 23.9%, des bons résultats dans 56.6%, des résultats moyens dans 15% et des résultats mauvais dans 4.4% de patients. Un âge supérieur à 65 ans (valeur 0.004 de P), un comminution significative [A3 ou C3 dans classification AO ] (valeur 0.007 de P) et une fracture ulnaire associée (valeur 0.015 de P) étaient les variables avérées pour avoir statistiquement la corrélation significative avec de mauvais résultats radiologiques.

Mots clés

Fracture distale du radius Broches de Kirschner Stabilité Variables radiologiques 


  1. 1.
    Abraham Colles (1814) The classic. On the fracture of the carpal extremity of the radius. Edinburgh Med Surg J, Clin Orthop (1972) 83:3–5Google Scholar
  2. 2.
    Adams BD (1993) Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am 18(3):492–498Google Scholar
  3. 3.
    Andersen DJ, Blair WF, Steyers CM Jr, Adams BD, el-Khouri GY, Brandser EA (1996) Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg Am 21(4):574–582Google Scholar
  4. 4.
    Beumer A, McQueen MM (2003) Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand 74(1):98–100Google Scholar
  5. 5.
    Clancey GJ (1984) Percutaneous Kirschner-wire fixation of Colles fractures. A prospective study of thirty cases. J Bone Joint Surg Am 66(7):1008–1014Google Scholar
  6. 6.
    Doczi J, Frohlich P (1994) Prognostic evaluation of the classification of distal radius fractures, Magy Traumatol Ortop Kezseb Plasztikai Seb 37(4):347–354Google Scholar
  7. 7.
    Dutka J, Sosin P, Morawiecki P (2000) Influence of patient’s age and fracture morphology on the final result of conservative treatment, Chir Narzadow Ruchu Ortop Pol 65(2):183–190Google Scholar
  8. 8.
    Fujii K, Henmi T, Kanematsu Y, Mishiro T, Sakai T, Terai T (2002) Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong) 10 (1):9–15Google Scholar
  9. 9.
    Handoll HH, Madhok R (2003) Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev CD003209Google Scholar
  10. 10.
    Hollevoet N, Verdonk R (2003) The functional importance of malunion in distal radius fractures. Acta Orthop Belg 69(3):239–245Google Scholar
  11. 11.
    Kapandji A (1987) Intra-focal pinning of fractures of the distal end of the radius 10 years later. Ann Chir Main 6(1):57–63PubMedGoogle Scholar
  12. 12.
    Kaukonen JP, Karaharju EO, Porras M, Luthje P, Jakobsson A(1988) Functional recovery after fractures of the distal forearm. Analysis of radiographic and other factors affecting the outcome. Ann Chir Gynaecol 77(1):27–31PubMedGoogle Scholar
  13. 13.
    Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF (1996) Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br 78(5):726–731Google Scholar
  14. 14.
    Kwasny O, Barisani GR, Schabus R, Hertz H (1991) Results and analysis of poor results after conservative therapy of distal radius fracture, Handchir Mikrochir Plast Chir 23(5):240–244Google Scholar
  15. 15.
    Lafontaine M,Hardy D, Delince (1989) Stability assessment of distal radius fractures. Injury 20:208–210CrossRefPubMedGoogle Scholar
  16. 16.
    Miyake T, Hashizume H, Inoue H, Shi Q, Nagayama N (1994) Malunited Colles’ fracture. Analysis of stress distribution. J Hand Surg Br 19(6):737–742Google Scholar
  17. 17.
    Naidu SH, Capo JT, Moulton M, Ciccone W 2nd, Radin A (1997) Percutaneous pinning of distal radius fractures: a biomechanical study. J Hand Surg Am 22(2):252–257Google Scholar
  18. 18.
    Oskam J, Kingma J, Bart J, Klasen HJ (1997) K-wire fixation for redislocated Colles’ fractures. Malunion in 8/21 cases. Acta Orthop Scand 68(3):259–261Google Scholar
  19. 19.
    Oskarsson GV, Aaser P, Hjall A (1997) Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures? Arch Orthop Trauma Surg 116(6–7):341–344Google Scholar
  20. 20.
    Porter M, Stockley I (1987) Fractures of the distal radius. Intermediate and end results in relation to radiologic parameters. Clin Orthop 220:241–252Google Scholar
  21. 21.
    Short WH, Palmer AK, Werner FW, Murphy DJ (1987) A biomechanical study of distal radial fractures. J Hand Surg Am 12(4):529–534Google Scholar
  22. 22.
    Simic PM, Weiland AJ (2003) Fractures of the distal aspect of the radius: changes in treatment over the past two decades. Instr Course Lect 52:185–195Google Scholar
  23. 23.
    Stein AH Jr, Katz SF (1975) Stabilization of comminuted fractures of the distal inch of the radius: Percutaneous pinning. Clin Orthop 108:174–181Google Scholar
  24. 24.
    Stewart HD, Innes AR, Burke FD (1985) Factors affecting the outcome of Colles’ fracture: an anatomical and functional study. Injury 16(5):289–295Google Scholar
  25. 25.
    Trumble TE, Schmitt SR, Vedder NB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures, J Hand Surg Am 19(2):325–340Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Harish V. Kurup
    • 1
    • 2
    Email author
  • Vipul Mandalia
    • 1
  • B. Singh
    • 1
    • 3
  • K. A. Shaju
    • 1
  • R. L. Mehta
    • 1
    • 4
  • A. R. Beaumont
    • 1
  1. 1.Salisbury District HospitalSalisbury, WiltshireUK
  2. 2.Southampton University Hospitals NHS TrustSouthamptonUK
  3. 3.Queen Elizabeth HospitalWoolwich, LondonUK
  4. 4.University of Southampton School of MedicineSouthampton University Hospitals NHS TrustSouthamptonUK

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