K-wires as a valid alternative to dual and single headless cannulated compression screw fixation of chauffeur fractures: a biomechanical comparison.

PURPOSE: Chauffeur fractures represent a distinctive subset of distal radius fractures and typically arise from a high-energy axial load or a direct blow to the volar aspect of the wrist. In cases of significant displacement, joint incongruity or functional impairment, surgical intervention becomes crucial. However, up to date there is no consensus about the best osteosynthesis treatment option. Therefore, the aim of this study was to investigate the biomechanical competence of Chauffeur fractures fixed with either one headless cannulated compression screw, two headless cannulated compression screws, or two Kirschner (K-) wires.

METHODS

Eighteen right synthetic radii with a simulated Chauffeur fracture were assigned to three groups (n = 6) for fixation with either one headless cannulated compression screw (3.0 mm x 36 mm; Group 1), two K-wires (1.8 mm; Group 2), or two headless cannulated compression screws (2.2 mm x 30 mm and 2.2 mm x 36 mm; Group 3). The specimens underwent non-destructive biomechanical testing in neutral position, flexion, and extension, followed by progressively increasing cyclic loading to failure in neutral position with monitoring via motion tracking.

RESULTS

Initial construct stiffness in flexion was significantly lower in Group 3 (202.4 ± 32.8 N/mm) versus both Group 1 (283.6 ± 31.3 N/mm) and Group 2 (275.3 ± 57.8 N/mm), p < 0.05. Cycles to failure and failure load in Group 2 (9214 ± 644; 510.7 ± 32.2 N) and Group 3 (8282 ± 973; 464.1 ± 48.7 N) were both significantly higher versus Group 1 (4678 ± 930; 283.9 ± 46.5 N), p < 0.05.

CONCLUSION

Whereas treatment of Chauffeur fractures with one cannulated compression headless screw is not recommended, using two K-wires is a valid alternative to the fixation of such fractures with two headless cannulated compression screws.