Treatment of unstable distal radial fractures by intrafocal, intramedullary K-wires.

Displaced distal radial fractures with extensive dorsal comminution and plastic cancellous deformation are unstable and frequently cause treatment problems since there is no single, reliable method of treatment, notably in osteoporotic bone. We present a method of holding unstable distal radial fractures with blunt ended K-wires via intrafocal and intramedullary insertion, so modifying the Kapandji technique. Wires were placed dorsally, radially and when necessary from the volar direction depending on fracture configuration. Over a 7-year period (1992-1999) we treated 102 patients with unstable distal radial fractures in this way. Of these, 80 were followed up for 6-42 weeks according to clinical need and scored radiologically and functionally using modified Lidstrom scoring system. Results showed that 92 and 95% of these patients achieved good or excellent results in these scoring systems, respectively. We present this as a useful and reliable method of treating these common fractures, particularly in osteoporotic bone.