Stability of Distal Radius Styloid Fractures using Kirschner Wires versus Cortical Screw – Biomechanical Study
DOI:
https://doi.org/10.21270/archi.v12i4.6119Keywords:
Biomechanical Phenomena, Wrist Fractures, Orthopedic Equipment, Prostheses and ImplantsAbstract
Introduction: Displaced radial styloid fractures can be surgically managed using several osteosynthesis techniques. This biomechanical study compared two fixation techniques used in radial styloid fracture management, one with two converging Kirschner wires and the other with a cortical screw and washer. Methods: 10 models of the distal end of the radius were created, reproducing the fracture of the radial styloid, type AO/OTA 2R3 B1.1, using a 3D printer and dimensions identical to those of the Sawbones® 3047 model used in the previous biomechanical tests. The models were divided into two groups containing five units each. One of the groups was fixed with 2 converging 1.5 mm Kirschner wires and the other with a 3.5 mm cortical screw and washer. The variables compared were maximum force, deflection, and stiffness during mechanical axial compression tests.Results: it was observed that maximum force, deflection, and energy are, on average, greater in specimens fixed with Kirschner wire than in specimens with a screw and washer (Student's t-test, p<0.05). In turn, stiffness was higher in evaluating specimens fixed with a screw and washer than with Kirschner wire (Student's t-test, p<0.05). Conclusion: both techniques can allow early mobilization, with additional rigidity of the compressive screw.
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Stanbury SJ, Salo A, Elfar JC. Biomechanical analysis of a volar variable-angle locking plate: the effect of capturing a distal radial styloid fragment. J Hand Surg Am. 2012;37(12):2488-94.
Hozack BA, Tosti RJ. Fragment-Specific Fixation in Distal Radius Fractures. Curr Rev Musculoskelet Med. 2019;12(2):190-97.
Wæver D, Madsen ML, Rölfing JHD, Borris LC, Henriksen M, Nagel LL, et al. Distal radius fractures are difficult to classify. Injury. 2018;49 Suppl 1:S29-S32.
Andreotti M, Tonon F, Caruso G, Massari L, Riva MA. The "Chauffeur Fracture": Historical Origins of an Often-Forgotten Eponym. Hand (N Y). 2020;15(2):252-54.
Lund FB. Fracture of the radius in starting automobiles. Boston Med Surg J. 1904;18:481-83
Fujioka H, Tsunemi K, Tanaka J. Bilateral stress fractures of the radial styloid processes in a gymnast. J Hand Surg Eur Vol. 2010;35(3):243-44.
Melone CP Jr. Articular fractures of the distal radius. Orthop Clin North Am. 1984;15(2):217-36.
Fricker R, Jupiter J E Kastelec M. Distal forearm Partial articular, sagittal simple radial fracture, involving scaphoid fossa. AO Surgery Reference, 2019.
Ring D, Jupiter JB. Percutaneous and limited open fixation of fractures of the distal radius. Clin Orthop Relat Res. 2000;(375):105-15.
Habernek H, Weinstabl R, Fialka C, Schmid L. Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations, technique, and results. J Trauma. 1994;36(1):83-8.
Chen Y, Zheng X, Wang J, Zhu Y, Zhan C. Reliable techniques to avoid damaging the superficial radial nerve due to percutaneous Kirschner wire fixation of the distal radius fracture through the radial styloid process. Surg Radiol Anat. 2010;32(8):711-17.
Jakob M, Rikli DA, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. A prospective study of 73 consecutive patients. J Bone Joint Surg Br. 2000;82(3):340-44.
Appel LJ. A primer on the design, conduct, and interpretation of clinical trials. Clin J Am Soc Nephrol. 2006;1(6):1360-67.
Freeland AE, Geissler WB. The arthroscopic management of intra-articular distal radius fractures. Hand Surg. 2000;5(2):93-102.
Drobetz H, Weninger P, Grant C, Heal C, Muller R, Schuetz M, et al. More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates. Injury. 2013;44(4):535-39.
Neder Filho AT. Estabilidade de fraturas intra-articulares da extremidade distal do rádio utilizando placas volares bloqueadas com parafusos unicorticais e bicorticais [tese]. Ribeirão Preto: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP); 2017.
Rausch S, Klos K, Stephan H, Hoffmeier K, Gras F, Windolf M, et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model--a biomechanical study. Injury. 2011;42(11):1248-52.
Reichel LM, Bell BR, Michnick SM, Reitman CA. Radial styloid fractures. J Hand Surg Am. 2012;37(8):1726-41
Helm RH, Tonkin MA. The chauffeur's fracture: simple or complex? J Hand Surg Br. 1992;17(2):156-59.
Nakamura T, Cooney WP 3rd, Lui WH, Haugstvedt JR, Zhao KD, Berglund L, et al. Radial styloidectomy: a biomechanical study on stability of the wrist joint. J Hand Surg Am. 2001;26(1):85-93.
Zhang X, Zhang Y, Fan J, Yuan F, Tang Q, Xian CJ. Analyses of fracture line distribution in intra-articular distal radius fractures. Radiol Med. 2019;124(7):613-19.
Liu X, Wu WD, Fang YF, Zhang MC, Huang WH. Biomechanical comparison of osteoporotic distal radius fractures fixed by distal locking screws with different length. PLoS One. 2014; 9(7):e103371.
Yammine K, Rafi SM, Furhad S. Tendon and neurovascular injuries of the distal radius after pinning with Kirschner wires: A meta-analysis of cadaveric studies. Clin Anat. 2015;28(4):545-50.
Albeny TAP, Vaz BAS, Rezende LGRA, Shimaoka FJ, Cagnolati AF, Irusta AC et al. Correlação clínico-radiográfica Das Fraturas Articulares Completas do rádio Distal Tratadas Cirurgicamente. Arch Health Invest. 2020;9(3):211-15.
Takase K, Morohashi A. A case of acute dorsal radiocarpal dislocation with radial styloid fracture. Eur J Orthop Surg Traumatol. 2013;23 Suppl 2:S197-201.
Putnam MD, Meyer NJ, Nelson EW, Gesensway D, Lewis JL. Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation. J Hand Surg Am. 2000;25(3):469-75.
Willis AA, Kutsumi K, Zobitz ME, Cooney WP 3rd. Internal fixation of dorsally displaced fractures of the distal part of the radius. A biomechanical analysis of volar plate fracture stability. J Bone Joint Surg Am. 2006;88(11):2411-17.
An KN, Chao EY, Cooney WP, Linscheid RL. Forces in the normal and abnormal hand. J Orthop Res. 1985;3(2):202-11.
Liporace FA, Gupta S, Jeong GK, Stracher M, Kummer F, Egol KA, Koval KJ. A biomechanical comparison of a dorsal 3.5-mm T-plate and a volar fixed-angle plate in a model of dorsally unstable distal radius fractures. J Orthop Trauma. 2005;19(3):187-91.
