A COMPARATIVE STUDY BETWEEN CLOSED REDUCTION AND CAST APPLICATION VERSUS PERCUTANEOUS K-WIRE FIXATION AND CAST APPLICATION FOR FRACTURE DISTAL END OF RADIUS

Abstract

Introduction: Fracture of distal end radius is the common type of fractures constituting upto 18% cases in adult age group and upto 25% cases in paediatric age group. This distal end radius fracture was common among elderly population who sustained fracture due to low energy trauma which is attributed to osteoporotic bone. But in recent years there is increase in the incidence due to rise in the road traffic accidents especially in younger age group. Closed reduction and cast immobilization is an effective way of treating elderly patient with stable distal radius fracture but it often results in malunion and poor functional outcome. Closed reduction, percutaneous K-wire fixation and below elbow cast application is a simple and minimally invasive surgical procedure that provides additional stability to maintain the reduction of fracture and offers good radiological outcome in fracture distal end radius both extraarticular fractures and extraarticular fractures with simple intraarticular extension. Objectives: 1. Management of the fracture distal end radius by closed reduction and cast application. 2. Management of the fracture distal end radius by closed reduction, percutaneous K-wire fixation and cast application. 3. To compare the functional outcome between the two methods using Gartland and Werley demerit point scoring system. XIII Materials and methods: This was a prospective study consisting of 44 patients, conducted at R.L.J. HOSPITAL AND RESEARCH CENTRE, attached to SRI DEVARAJ URS MEDICAL COLLEGE, Kolar from December 2018 to September 2020. 44 patients with distal end radius fracture patients were allocated into two groups consisting of 22 patients in each group using computer generated simple randomization protocol. Group A was managed by closed reduction and cast application. Group B was managed by closed reduction, percutaneous K-wire fixation and cast application. Results: Evaluation of the functional outcome was done using demerit point scoring system of Gartland and Werley. In group A i.e., closed reduction and cast application 31.8% had excellent, 40.9% had good, 22.7% had fair and 4.5% had poor Gartland & Werley results. In group B i.e., closed reduction, percutaneous K-wire fixation and cast application 36.4% had excellent, 45.5% had good, 13.6% had fair and 4.5% had poor Gartland & Werley results. There was no statistically significant difference in functional outcome between two groups. Conclusion: We conclude that there is statistically insignificant difference in the functional outcome of the fracture distal end radius (extraarticular and extraarticular with simple intraarticular extension) managed by closed reduction and cast application as compared to closed reduction, percutaneous K-wire fixation and cast application. However, there is a statistically significant difference in the radiological outcome in terms of radial height, volar tilt and radial inclination in the closed reduction, percutaneous k- wire fixation and cast application group when compared to closed reduction and cast application only. Thereby, suggesting that percutaneous K- wire fixation provides additional stability which favours anatomic reduction of distal end radius fracture.