Background: The treatment of displaced Colles-type fractures of the
distal part of the radius remains a challenge. Two procedures for closed
reduction and Kirschner wire osteosynthesis of these fractures were compared
in a prospective randomized study.
Methods: One hundred consecutive patients with a Colles fracture of
the distal part of the radius (AO classification 23-A2, 23-A3, or 23-C1) were
treated over an eighteen-month period. One group was managed with the
conventional method, described by Willenegger and Guggenbühl in 1959, in
which two Kirschner wires are introduced into the styloid process of the
radius. The other group was treated with the Kapandji method, as modified by
Fritz et al., in which two Kirschner wires are inserted into the fracture gap
and a third is placed through the styloid process. Postoperative care was
standardized for both groups and carried out according to a strict procedure.
Forty patients who had been operated on according to the modified Kapandji
method and forty-one treated with the Willenegger technique were available for
follow-up, for a follow-up rate of 81%. The follow-up assessment was performed
with a modified version of the Martini score.
Results: The median time to follow-up was ten months (range, six to
twenty months). The results as assessed with the Martini score were, on the
average, good to very good for the patients treated with the Kapandji method
and satisfactory to good for the patients treated with the conventional
Kirschner wire fixation. The duration of radiographic exposure was
significantly shorter with the Kapandji method than with the Willenegger
Conclusions: Conventional Kirschner wire fixation remains a good
method of osteosynthesis for the treatment of displaced fractures of the
distal part of the radius. We found both the functional and radiographic
outcomes of the Kapandji method to be significantly better than those of the
Level of Evidence: Therapeutic study, Level I-1a
(randomized controlled trial [significant difference]). See Instructions to
Authors for a complete description of levels of evidence.