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.
Keywords
Distal radius - Percutaneous - Kirschner wire - Complication - Superficial radial
nerve - Lateral cutaneous nerve of forearm - Dorsal branch of ulnar nerve - Cephalic
vein - Radial artery
