OUTCOME FOLLOWING BURIED VERSUS EXPOSED KIRSCHNER WIRING OF DISTAL RADIUS FRACTURES; A RANDOMISED CONTROLLED TRIAL.

Introduction: K wiring is a popular technique to help maintain anatomic reduction of distal radial fractures. It has the advantage of being a semi-closed procedure, which is simple to perform. Complications related to K wires include infection, migration and damage to tendons and nerves. We aimed to perform a randomized prospective study to determine the outcome of Buried versus Exposed K wire placement. Methods: We prospectively recruited 60 consecutive patients with displaced distal radius fractures requiring K wiring to our study. They were randomized to Buried versus Exposed K wire groups. Patient details were collected and follow up was performed at 2 and 6 weeks post op. Infection at pin sites was measured on a 0 to 6 point scale. Superficial radial nerve was assessed with light touch and 2 point discrimination. EPL tendon was also assessed for damage. Results: 60 consecutive patients were recruited to the study and randomized to buried or exposed k wires. There were 30 patients in each group. No damage to EPL tendon was recorded in either group at 6/52 follow up. There was a slight increased rate of superficial infection at exposed pin sites noted at 2/52 follow up however this was not seen at the 6/52 follow up. Superficial radial nerve damage was noted in one case only. This was in the buried k wire group and occurred following removal of the radial wire. Conclusion: There appears to be slight increased risk of superficial pin site infection in the exposed k wire group at 2/52 but this is not seen at 6/52 follow up. Buried k wires require a second procedure to remove the wires and this runs the risk of superficial radial nerve damage. Thus it would appear that leaving k wires exposed is the safer and more convenient method of K wiring the displaced distal radius fracture.