Satish BRJ, Vinodkumar M, Suresh M, Seetharam PY, Jaikumar K. Closed reduction and K-wiring with the Kapandji technique for completely displaced pediatric distal radial fractures.
Orthopedics 2014;
37:e810-6. [PMID:
25350624 DOI:
10.3928/01477447-20140825-58]
[Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
In completely displaced pediatric distal radial fractures, achieving satisfactory reduction with closed manipulation and maintenance of reduction with casting is difficult. Although the Kapandji technique of K-wiring is widely practiced for distal radial fracture fixation in adults, it is rarely used in pediatric acute fractures. Forty-six completely displaced distal radial fractures in children 7 to 14 years old were treated with closed reduction and K-wire fixation. One or 2 intrafocal K-wires were used to lever out and reduce the distal fragment's posterior and radial translation. One or 2 extrafocal K-wires were used to augment intrafocal fixation. Postoperative immobilization was enforced for 3 to 6 weeks (with a short arm plaster of Paris cast for the first half of the time and a removable wrist splint for the second half), after which time the K-wires were removed. Patients were followed for a minimum of 4 months. Mean patient age was 9.5 years. Near-anatomical reduction was achieved easily with the intrafocal leverage technique in all fractures. Mean procedure time for K-wiring was 7 minutes. On follow-up, there was no loss of reduction; remanipulation was not performed in any case. There were no pin-related complications. All fractures healed, and full function of the wrist and forearm was achieved in every case. The Kapandji K-wire technique consistently achieves easy and near-anatomical closed reduction by a leverage reduction method in completely displaced pediatric distal radial fractures. Reduction is maintained throughout the fracture-healing period. The casting duration can be reduced without loss of reduction, and good functional results can be obtained.
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