Kirschner Wire Fixation of Distal Radius Fractures, Indication, Technique and Outcomes

Comparing AAOS appropriate use criteria with ChatGPT-4o recommendations on treating distal radius fractures

INTRODUCTION

The American Academy of Orthopaedic Surgeons (AAOS) developed appropriate use criteria (AUC) to guide treatment decisions for distal radius fractures based on expert consensus. This study aims to evaluate the accuracy of Chat Generative Pre-trained Transformer-4o (ChatGPT-4o) by comparing its appropriateness scores for distal radius fracture treatment with those from the AUC.

METHODS

The AUC patient scenarios were categorized by factors such as fracture type (AO/OTA classification), mechanism of injury, pre-injury activity level, patient health (ASA 1-4), and associated injuries. Treatment options included percutaneous pinning, spanning external fixation, volar locking plates, dorsal plates, and immobilization methods, among others. Orthopedic surgeons assigned appropriateness scores for each treatment (1-3 = "Rarely Appropriate," 4-6 = "May Be Appropriate," and 7-9 = "Appropriate"). ChatGPT-4o was prompted with the same patient scenarios and asked to assign scores. Differences between AAOS and ChatGPT-4o ratings were used to calculate mean error, mean absolute error, and mean squared error. Statistical significance was assessed using Spearman correlation, and appropriateness scores were grouped into categories to determine percentage overlap between the two sources.

RESULTS

A total of 240 patient scenarios and 2160 paired treatment scores were analyzed. The mean error for treatment options ranged from 0.6 for volar locking plate to -2.9 for dorsal plating. Pearson correlation revealed significant positive associations for dorsal spanning bridge (0.43, P = <0.001) and spanning external fixation (0.4, P = <0.001). The percentage overlap between AAOS and ChatGPT-4o in the appropriateness categories varied, with 99.17% agreement for immobilization without reduction, 90.42% for volar locking plates, and only 15% for dorsal plating.

CONCLUSION

ChatGPT-4o does not consistently align with the appropriate use criteria in determining appropriate management of distal radius fractures. While there was moderate concordance in certain treatments, ChatGPT-4o tended to favor more conservative approaches, raising concerns about the reliability of AI-generated recommendations for medical advice and clinical decision-making.

Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials

Objective  This study aims to compare the outcomes of volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of unstable distal radius fractures. Methods  We systematically searched multiple databases, including MEDLINE, EMBASE, Cochrane Central till January 2022 for randomized controlled trials (RCTs) that met eligibility criteria. Following outcomes were evaluated at 6-week, 3-, 6-, and 12-month follow-up period: Disabilities of the Arm, Shoulder, and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) score, grip strength, range of motion, and complication incidence. Meta-analysis was performed using random effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval. Results  Fourteen RCTs with 1,450 participants met the inclusion criteria. DASH scores were significantly better for VLP fixation at 6th week (MD = 19.02; p  < 0.001), 3rd (MD = 10.79; p  < 0.001), 6th (MD= 7.78; p  < 0.001), and 12th month (MD = 2.94; p  < 0.001) postoperation. At 3-month follow-up period, VLP treatment exhibited better grip strength (MD = - 10.32; p  < 0.001) and PRWE scores (MD = 8.78; p  < 0.001). There was a statistically significant early advantage in flexion, extension, pronation, supination, radial deviation, and ulnar deviation in the VLP group at 6-week follow-up, but at 1-year follow-up only significantly better extension was observed. At 1 year, radiographic outcomes were similar except for volar tilt favoring VLP fixation ( p  < 0.001). Superficial infections were more common in patients treated with K-wire (RR = 2.89; p  = 0.001), but there was no difference in total complications or reoperation rates ( p  > 0.05). Conclusion  This meta-analysis suggests that VLP fixation and K-wire fixation are both effective procedures, but existing literature does not provide sufficient evidence to demonstrate the superiority of either method. Although VLP fixation improves DASH score, extension and volar tilt at 12-month follow-up, the difference is small and unlikely to be noticeable to the patients.

Treatment of distal radius fractures using a cemented K-wire frame

BACKGROUND

This retrospective study included an alternative treatment for types A2, A3, and B1 distal radius fractures using percutaneous fixation with a cemented K-wire frame.

METHODS

From January 2017 to January 2020, 78 patients with distal radius fractures were treated with percutaneous internal fixation using a cemented K-wire frame. There were 47 male patients and 31 female patients. The fractures were classified into types A2 (n = 10), A3 (n = 46), and B1 (n = 22). X-rays were taken immediately after surgery and after the bone had healed. Wrist function was assessed using the Mayo Wrist Score (90-100, excellent; 80-90, good; 60-80, satisfactory; < 60, poor). Patient satisfaction was assessed using the 10-cm visual analog scale.

RESULTS

Neither fixation failure nor K-wire migration was found (P > 0.05). Osteomyelitis was not observed in this series. All patients achieved bone healing after a mean of 4.5 weeks (range, 4 to 8 weeks). Follow-up lasted a mean of 27 months (range, 24 to 33 months). The mean score of wrist function was 97 (range, 91 to 100). Among them, 66 results were excellent and 12 results were good. The mean patient satisfaction was 10 cm (range, 8 to 10 cm).

CONCLUSIONS

Percutaneous fixation with cemented K-wire frame is a safe and preferred choice for the treatment of types A2, A3, and B1 distal radius fractures. The frame provides support to prevent wire migration. The fixation technique is a minimally invasive procedure that is easy to perform.

LEVEL OF EVIDENCE

Therapeutic study, Level IVa.