K-Wiring Distal Radial Fractures, an Alternative Technique

BACKGROUND

K-wiring of distal radial fractures is traditionally performed with the patient supine and the affected arm laid laterally on either the image intensifier or an arm table.¹ Manipulation is performed, the fracture reduced and position checked with the image intensifier. The K-wires are then inserted. During this process, constant traction is not maintained and, therefore, the reduction may be lost. We utilise a technique allowing constant traction thus facilitating insertion of the K-wires and, therefore, maintaining reduction throughout the procedure.

TECHNIQUE

The patient is placed supine on the operating table with a tourniquet placed on the arm (Fig. 1). The shoulder is abducted 90° and the elbow flexed to approximately 70°. A vertical bolster is fixed to the table so as to hold the arm in this position when longitudinal traction is applied across the wrist. An arm table is then attached to the table caudal to the bolster. The tourniquet is inflated and the arm painted and draped in standard fashion. A large, upturned kidney dish is placed under the forearm and longitudinal traction applied to the thumb and fingers by the assistant. The kidney dish aids reduction by placing the wrist in palmar flexion. The c-arm can now be brought in from the patient's lateral side. The assistant can rotate the arm, whilst maintaining traction, to get 90° views if the wrist. Once adequate reduction is achieved, K-wires can be inserted in the standard fashion.

Figure 1.

K-wire technique.

DISCUSSION

We have used this technique for the above procedure and also application of external fixators.