Tendon and neurovascular injuries of the distal radius after pinning with Kirschner wires: A meta-analysis of cadaveric studies.

Abstract

Tendon and nerve structures are at risk when displaced fractures of the distal radius are pinned using K-wires. The aim of this meta-analysis (MA) is to examine the published evidence of such complications in cadavers. Eight studies met our inclusion criteria. The meta-analytical results were as follows: (a) 2.87% and 30.5% tendon involvement at the radial styloid process (RSP) and the dorso-radial area of the distal radius, respectively; (b) 3.5% and 1.1% tendon involvement when the percutaneous pinning (PP) and the limited open pinning (LOP) techniques were used, respectively; (c) 16.1% and 3.4% nerve involvement at the RSP and the dorso-radial area of the distal radius, respectively; (d) in 35.7% the nerve was speared and in 64.3% it touched the K-wire at the styloid area; (e) 61.3% cephalic vein involvement in the styloid area; (f) the second branch of the sensitive branch of the radial nerve (SBRN) was the closest to a wire inserted into the RSP; (g) the mean (±SD) distance between a branch of the SBRN and a styloid wire was 2.17 ± 0.82 mm. Our results for nerve and tendon injury frequencies in the RSP were close to those in clinical meta-analytical studies, offering an excellent statistical model of evidence synthesis based on cadaveric studies to assess the frequency of such injuries in clinical practice. However, this cadaveric MA yielded more accurate data than the previously reported clinical MA in assessing the real risk of injury of such structures in the distal radius in terms of their proximity to the inserted K-wires.