Is Fixation With K-Wire Sufficient In Distal Radioulnar Joint Instability Accompanying The Distal Radius Fracture?

Abstract

Introduction: Distal radius fractures are the most common fractures of the upper extremity. Recently, the tendency towards surgical treatment has increased in distal radius fractures. Distal radioulnar joint instability is thought to negatively affect the results of distal radius fracture. Our aim in this study is to compare the patients with and without distal radioulnar joint instability, who were operated with the diagnosis of distal radius fracture, clinically and radiologically. Materials and methods: 31 patients who were operated with the diagnosis of distal radius fracture and whose fracture union was completed were included in the study. Patients with an isolated distal radius fracture (19 individuals) were called group 1, while patients with a distal radioulnar joint instability accompanying the distal radius fracture (12 individuals) were called group 2. The groups were compared functionally with DASH and MAYO scores in terms of pain and radiologically with VAS score in terms of radial length, radial slope and volar slope. Joint range of motion was also measured with a standard goniometer and compared between the groups. Results: In the group with isolated distal radius fractures, 11 (57.9%) patients were male and 8 (42.1%) were female. The mean length of follow-up was 22.5 months. In the group with distal radius fractures and accompanying distal radioulnar joint instability, 9 (75.0%) patients were male and 3 (25.0%) were female. The mean length of follow-up in this group was 27.08 months. There was no difference between MAYO, DASH and VAS scores between the groups (p>0.05). The mean radial length was 9.95 ± 1.96 (6; 14) in group 1 and 10.67 ± 2.71 (4; 15) in group 2. The mean radial slope was 19.53 ± 2.78 (14; 26) in group 1 and 18.92 ± 3.6 (11; 26) in group 2. The mean volar slope was 8.32 ± 3.59 in group 1 and 6.92 ± 4.81 (-2; 14) in group 2. It was understood that there was no significant difference between the groups (p>0.05). While the mean supination angle was 80.53 ± 6.64 (60; 90) in group 1, it was 85.42 ± 5.42 (75; 90) in group 2, and it was found to be significantly higher in group 2 (p<0.05). The mean pronation angle was significantly lower in group 2 (p<0.05). Conclusions: DRUJ instability after a distal radius fracture is an important factor affecting the functional outcome. Providing distal radioulnar joint stability is important in this sense. In our study, immobilization treatment in full supination and percutaneous transfection with radioulnar K-wire for 4-6 weeks in patients with distal radioulnar joint instability is associated with good functional outcomes