Transepiphyseal percutaneous intramedullary Kirschner wire (TEPIK) in diametaphyseal radius fractures (DMRF) – experiences in 59 children

Abstract

Background: Distal forearm fractures are widespread in children and adolescents. The radial transition zone between diaphysis and metaphysis is not universally defined. Still, diametaphyseal radius fractures (DMRF) are prone to complications, and a commonly agreed standard for their treatment has yet to be established. Methods: We report on 59 children with unstable DMRF treated with a transepiphyseal, percutaneous, intramedullary K-wire (TEPIK) from 2010 to 2020. After fracture reduction, the patient's hand is held in palmar flexion. Next, a 1.8-2mm K-wire is inserted just beyond Lister's tubercle through the epiphysis and advanced, crossing the physis straight into the medullary cavity of the diaphysis. We report radiographic geometry before and after the treatment, operation times, course of treatment, functional results, and complications. Results: We saw no loss of reduction and no remaining functional deficits. Surgical trainees performed this technique in 71.2%. The mean operating time was 29 minutes. Percutaneous K-wires could be removed without anesthesia or sedation in our outpatient clinic in 81.4%. We saw two refractures after a second high-energy trauma and seven K-wires that migrated subcutaneously because they were cut too short. Conclusion: TEPIK is a quick and easy treatment for unstable DMRF. It provides safe management with a single, definite surgery if metal removal of an ulnar ESIN is unnecessary. This study is one of the most extensive series on the surgical treatment of DMRF reported in the literature and presents successful results of TEPIK in the treatment of unstable DMRF.

Keywords

• diametaphyseal radius fracture
• Kirschner wire
• K-wire
• TEPIK
• distal radius fracture
• children