title: An Anatomical Study to Demonstrate the Proximity of Kirschner Wires to Structures at Risk in Percutaneous Pinning of Distal Radius Fractures.
abstract: Distal radius fractures are often treated using percutaneous Kirschner wires (K-wires). The sensory nerves in this area, extensor tendons, radial artery and cephalic vein are at risk of injury in this procedure. We undertook a cadaveric investigation to identify probability of damage to these 'at risk' structures by measuring their distances in relation to standard K-wire sites. Nine upper limbs from six formalin-preserved cadavers were studied. Four K-wires were placed percutaneously simulating fixation of a distal radius fracture. Careful dissection was done preserving the original position of neurovascular and tendinous structures. Distances to relevant soft-tissue structures from each K-wire were measured using an electronic digital caliper. Distance of superficial nerves from radial styloid and Lister's tubercle was measured to determine their 'safe distance' from these fixed landmarks. None of the superficial nerves were injured by a K-wire. Cephalic vein had been pierced on 4 occasions (4/18) and extensor tendons on 3 occasions (3/18). Wilcoxon signed-rank test was used to compare distance of the superficial nerves from radial styloid and Lister tubercle, and the latter was found to be the safer option. This study highlights the inherent danger in percutaneous K-wire fixation of wrist fractures. Limited size of the area, where K-wires can be positioned, and anatomic variations of neurovascular structures pose obstacles in developing guidelines for reducing risk of injury. We advocate use of mini-open approach and guiding devices to avert complications of inadvertent impalement and damage to these structures.
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Bhopal, MP 462020 India.
authors.forename: John A
authors.initials: JA
authors.lastname: Santoshi
authors.affiliation: Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Bhopal, MP 462020 India.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chaware
authors.affiliation: Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, MP 462020 India.
authors.forename: Abhijit P
authors.initials: AP
authors.lastname: Pakhare
authors.affiliation: Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Bhopal, MP 462020 India.
authors.forename: Bertha A D
authors.identifier: 0000-0002-8459-4074
authors.initials: BA
authors.lastname: Rathinam
keywords: Cephalic vein; Complication; Distal radius; Dorsal branch of ulnar nerve; Kirschner wire; Lateral cutaneous nerve of forearm; Percutaneous; Radial artery; Superficial radial nerve