Intramedullary K-wire Fixation Research Articles

Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children

Aim of the workThis study was designed to highlight internal fixation by intramedullary K-wires for displaced distal forearm fractures among children and analyze the results of this technique. We hypothesize that physis-sparing intramedullary fixation prevents displacement with a lower complication rate.MethodsThis prospective case series involving 47 patients was conducted between February 2018 and December 2019. All patients with open physis presented with recent displaced distal forearm fractures were included, and all of them were treated with an intramedullary k-wire fixation for both bones with the assessment of the union rate, union time, suspected complication, radiographic evaluation, and functional outcome.ResultsThe study population consisted of 31 boys (66%) and 16 girls (34%). The mean age of the patients was 10.68 ± 2.728 years (range, 7–15 years). All fractures were united in a median of 6 weeks (range, 4–8 weeks), The functional outcome after 12 months was normal in 42 patients (89.4%), whereas, in five patients (10.6%), the functional parameters were minimally reduced. The median preoperative angulation improved from 36° (range, 24°–52°) preoperatively to 4° (range, 0°–10°) on immediate postoperative radiographs. After 12 months, the median angulation was 2° (range, 0°–7°) (p < 0.001). The angulation of the distal radius immediately after surgery and at the final follow-up was statistically correlated with the functional outcome (p < 0.001 and 0.002, respectively).ConclusionThis technique provides a good result with less susceptibility to re-displacement and low complication rates.Level of evidenceLevel IV.

Novel Extramedullary Fixation Device for Hammertoe Correction: A Retrospective Review of 100 patients

Classically, one of the more common treatment options for rigid hammertoe correction consists of end-to-end arthrodesis stabilized by temporary Kirschner wire (K-wire) fixation maintained until osseous consolidation or complication necessitating premature removal. However, single K-wire fixation allows for axial rotation which results in loss of compression at the arthrodesis site. To counteract this, intramedullary implants were designed to provide fusion site stability in all planes negating extra-skeletal extension of the wire. Nevertheless, manual pressfit implants arguably offer less reliable positioning of the fusion site in a true end to end orientation due to variation in intramedullary stem placement compared to direct visualization with dorsal plating. Larger diameter implants create an osseous void at the bony interface reducing the potential of true bony union. Hammertoe implant failure poses a unique and challenging salvage scenario which can ultimately end in amputation. Extramedullary fixation is uniquely designed to merge both benefits of K-wires and intramedullary implants while eliminating inadequacies of each. A total of 100 patients who underwent 150 rigid hammertoe corrections with an extramedullary implant were retrospectively reviewed. The mean postoperative follow-up was 12.6 months (range 12-18 months). Overall, 94 of 100 patients (94%) achieved radiographic union, defined by 2 or more bridged cortices at the arthrodesis site without signs of hardware breakage or signs of lucency across one or more fusion sites at a mean 8.8 weeks (range 7-10 weeks). This study demonstrated excellent results in regards to postoperative arthrodesis when utilizing an extramedullary implant for hammertoe deformity correction. This device minimizes osseous deficit by extramedullary application, all while augmenting intramedullary K-wire fixation.

Intramedullary K-wires versus Alternate Techniques for Metacarpal Shaft and Neck Fractures: A Systematic Review and Meta-analysis

Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/quickDASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time (p = 0.04; mean difference = − 13; 95% confidence interval = −26 to −0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.

Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization.

This study aims to evaluate the outcomes of single intramedullary K-wire fixation in nonthumb, metacarpal shaft fractures with immediate postoperative hand mobilization without any immobilization. This is a retrospective case series conducted from January 2019 to December 2022. We included patients with closed, simple transverse, or short oblique metacarpal shaft fracture treated with single, 1.4 mm, intramedullary K-wire fixation. Gentle postoperative range of motion exercise was encouraged in every patient without any hand, finger, or wrist motion restriction material. Clinical outcomes were evaluated with total active flexion; grip strength; disability of arm, shoulder, and hand (DASH) score; and the American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. This study included 34 patients, 25 males and 9 females with a mean age of 33.14 years (ranging 18-59). A total of 43 metacarpal shafts were treated. The mean DASH score at two and 6 weeks postoperative was 41.5 (ranging 19.16-60.34) and 9.58 (ranging 0.83-23.27). The mean final DASH score at last follow-up was 3.48 (ranging 0-8.33). Mean TAF at 2 weeks postoperative, 6 weeks postoperative, and at final follow-up was 203.8 (ranging 185-240), 238.2 (ranging 220-270), and 259.25 (ranging 240-270) degrees, respectively. The mean grip strength of the injured hand was 66.14 and 86.1% of the uninjured hand at 6 weeks and 3 months postoperative. There was no nonunion, malrotation, or infection. In conclusion, single intramedullary K-wire fixation gives excellent outcomes in the treatment of single or multiple, simple, metacarpal shaft fractures without the need of postoperative immobilization.

Comparison of Frequency of Union with Percutaneous Intramedullary Kirschner Wire versus Interfragmentary Screw Fixation in Displaced Extra-articular Metacarpal Fractures

Objective: To compare the frequency of union in cases treated with percutaneous intramedullary kirschner wire versus interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Study Design: Randomized controlled trial. Place and Duration: The Department of Othropedic surgery, Ghurki Trust Teaching Hospital Lahore, Pakistan from May 2021 to November 2021. Methodology: A total of 70 cases (35 in each group) of both genders aged 18-60 years with displaced extra-articular metacarpal fracture were included. Surgery was performed with the patient under peripheral anesthesia adopting pneumatic tourniquet and image intensification. Patients were randomly divided into 2 groups, undergoing either percutaneous intramedullary K-wire fixation or interfragmentary Screw Fixation. Patients were followed up till 16th week to see the union. Results: The mean age of patients in K-wire group was 37.89±9.34 years and in screw fixation group was 40.17±12.82 years. In K-wire group, there were 24 (68.57%) male and 11(31.4%) female cases while in Screw fixation group there were 17 (48.6%) male and 18 (51.4%) female cases. In K-wire group, 20 (57.1%) cases reported union while in Screw fixation group, 33 (94.3%) cases reported union at the final follow up (p&lt;0.001). Practical Implications: Interfragmentary screw fixation in displace extra-articular metacarpal fractures yielded better outcomes. Conclusion: Significantly more cases treated with interfragmentary screw fixation of displaced extra-articular metacarpal fractures reported union in comparison to percutaneous intramedullary kirschner wire. Keywords: Metacarpal fractures, internal fixation, intramedullary K-wire, screw fixation, union.

Outcome Analysis of Distal End Radius Fractures Managed With Antegrade Intramedullary K-wire Fixation.

Background The most frequent upper limb fractures are distal end radius fractures, accounting for around 17% of all fractures in clinical practice. Falling on an outstretched hand is the most common mechanism of injury, and it can also occur in high-energy trauma in young individuals. A minimally invasive technique ofpercutaneous pinning was introduced to sustain the fracture's reduction after manipulation and avoid there-displacement of fractured fragments. Antegrade intramedullary K-wire fixation is a cost-efficient procedure that can be done in rural settings. Methodology A total of 30 patients with fractures of the distal end radius managed with antegrade intramedullary K-wire fixation were included in the study. Operated patients were followed up at one month, three months, and six months for functionalassessment. An X-ray was taken on every follow-up to assess the union and implant positioning. Results In our study, the mean age was 45.6 years. Out of the 30 patients, 12 were males and 18 were females. All 30 patients at the final follow-up showed good functional improvement, with statistically significant improvements in palmar flexion, adduction and abduction, and pain scale scores. Conclusions Antegrade K-wire fixation is an effectivetechnique for fractures of the distal end radius that can be performed in rural settings with effective results.

Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study.

BackgroundVarious modalities of treatment have been used for the management of metacarpal and phalangeal fractures which include K-wire fixation, mini plates, lag screws fixation, intramedullary screw fixation and external fixator application. The aim of this study was to analyse complications and patient-related functional outcomes after antegrade or retrograde crossed intramedullary K-wire fixation of metacarpal and proximal phalangeal fractures.MethodsThirty-one patients (36–fractures, 16–metacarpals, 20–proximal phalanx) meeting the study criteria were included in this prospective study. Fixation of the fractures was done by use of crossed intramedullary K-wire using the principles of 3-point fixation.ResultsThe mean preoperative angulation of the fractures noted in this study was 35.8° which was significantly reduced at final follow-up. Union was noted at a mean period of 4.2 ± 6.8 weeks. The mean range of motion at the metacarpophalangeal and proximal interphalangeal joint was 96.4% and 86.3%, respectively as compared to the opposite hand. Stiffness (n = 3, 14.2%) and persistent pain (n = 2, 9.5%) at the joints were the most common complications noted in this study.ConclusionCrossed percutaneous intramedullary fixation of small bone fractures of the hand is a versatile method with advantages such as cost-effectiveness and lesser operative time when compared to other modalities of fixation. Earlier range of motion (ROM) exercises can be started due to preservation of gliding planes, no surgical wound along with good fracture stability and minimal hardware impingement.How to cite this articleAhmad S, Gupta T, Ansari S, et al. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. Strategies Trauma Limb Reconstr 2022;17(2):74–80.

Retrograde Intramedullary Kirschner Wire Fixation as an Alternative for Treating Distal Fibular Shaft Fractures Combined with Distal Tibial Pilon Fractures.

Treatment or management techniques for pilon fractures are associated with high complication rates and poor outcomes. No consensus exists regarding the optimal surgical option for pilon fractures, especially for pilon fractures combined with distal fibular fractures. Accordingly, we explored the use of fibular fixation for treating pilon fractures involving distal fibular shaft fractures. We hypothesized that retrograde intramedullary Kirschner wire (K-wire) fixation is a suitable alternative technique for distal fibular fixation. We retrospectively reviewed the data of 156 patients who underwent surgery for pilon fractures at our hospital from May 2013 to May 2021. The radiographic and functional outcomes were comparable between the fibular intramedullary nailing (Group A; n = 80) and the fibular plating (Group B; n = 76) groups. Groups A and B differed significantly in total hospitalization time (11.4 vs. 18.2 days, p = 0.024), length of postoperative admission (6.8 vs. 11.4 days, p = 0.012), and total admission cost (USD 3624 vs. USD 6145, p = 0.004). We also noted that poor Olerud and Molander ankle scores were significantly associated with age (p = 0.008), smoking (p = 0.012), and preoperative admission length (p = 0.018). Retrograde intramedullary K-wire fixation produced a comparable 12-month functional outcome to plate fixation for distal fibular shaft fractures, rendering it a viable alternative method based on soft tissue condition.

Comparison of Antegrade Percutaneous Intramedullary K-wire Fixation and Transverse Pinning for Treatment of Unstable Displaced Metacarpal Neck and Shaft Fractures: A Prospective Interventional Study

Introduction: Metacarpal fractures account for upto 10% of all body fractures and 36% of all hand fractures in adolescents, young adults, and active adults. Fractures of the metacarpal shaft and neck are common in all metacarpal fractures after direct trauma, roadside accidents, or sports injuries. The ratio of the shaft to the neck is 1:2. Closed reduction and plaster of paris cast can be used to treat the majority of these fractures conservatively. Unstable and comminuted fractures necessitate surgery. Aim: To compare the clinical, functional and radiological outcomes in antegrade intramedullary fixation and transverse pinning of metacarpal fractures in patients of unstable and displaced metacarpal shaft and neck fractures. Materials and Methods: A single-institutional prospective interventional study identified 60 cases of metacarpal fractures between November 2019 to August 2021. Each of the cases met the inclusion criteria for closed extra-articular fractures, displaced and unstable fractures of the metacarpal bone. The patients were divided into two groups having 30 subjects each, randomly allotted to two groups (Antegrade intramedullary K-wiring and Transverse Pinning). Outcomes were compared for range of movement by the American Society of Hand Surgeons Total Active Motion score (ASSH TAM), Visual Analog Scale (VAS), and radiological parameters (Angulation). Patients were followed-up for 12 weeks. Complications were listed in terms of pin site infection. Results: Most of the patients were found to be in the third decade of life. The fracture union was achieved at 8±2 weeks. Clinical evaluation done by VAS score which was found to be statistically insignificant between two groups (p-value=0.243). Radiological assessment evaluated by measuring postoperative angulation between two groups was found to be statistically insignificant (p-value=0.248). Difference in functional evaluation between the two groups done by ASSH TAM was found to statistically significant between the groups (p-value=0.036). Conclusion: Both antegrade intramedullary K-wiring and transverse pinning demonstrate good and comparable results for extra-articular neck and shaft metacarpal fractures. However, the former is superior in terms of final range of motion as per ASSH TAM score.

Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures.

We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation. Transverse mid-diaphyseal fractures were created in 64 metacarpal sawbones and were assigned into four groups. Peak load to failure and stiffness were measured in cantilever bending and torsion. We found that dorsal plating had the highest peak load to failure. However, initial bending stiffness of the 3.0 mm intramedullary headless compression screw was higher than that of the dorsal plates. In torsion testing, dorsal plating had the highest peak torque, but there was no significant difference in torsional stiffness between the plate and intramedullary headless compression screw constructs. We concluded that intramedullary headless compression screw fixation is biomechanically superior to K-wires in cantilever bending and torsion; however, it is less stable than dorsal plating. In our study, the initial stability provided by K-wire fixation was sufficient to cope with expected loads in the early rehabilitation period, whereas dorsal plates and IHCS constructs provided stability far in excess of what is required.

Retrospective analysis of Intramedullary K-Wire fixation of Metacarpal Fractures

Introduction: The majority of fractures of the metacarpal bones occur at a young age.Most of thetimes these metacarpal fractures can be treated conservatively in a POP slab(cock up slab)producing good functional results.Surgery was indicated in patients with palmar dislocation of &gt;30°and shortening of &gt;5 mm.Our study aimed to evaluate the clinical results of all metacarpal fracturestreated surgically by intramedullary Kirschner-wire fixation presented in our hospital.Materials andMethods: It was a retrospective study in which we included 50 patients with metacarpalfractures(both open andclosed) that came in our hospital, treated surgically by closed reduction andwere fixed with two intramedullary k-wires. Result: K-wires were removed after 4 weekspostoperatively,under local anaesthesia in the OPD. Metacarpal joint functions (flexion, extension,rotation) were clinically followed up in all patients, on the median periodof6 months (3 months to 9months). In our study, we found in all patients,flexion and extension were normal on bothsides.Conclusion: Closed reduction and intramedullary k-wire fixation of metacarpal bone fracturesproduce good functional results in the longterm. We found a very low rate of complication and thusrecommendthis surgical method for the stabilization of all these types of fractures.

Is intramedullary K-wire fixation still indicated in treatment midshaft clavicle fractures without comminution?

Is intramedullary K-wire fixation still indicated in treatment midshaft clavicle fractures without comminution?

Single Antegrade Intramedullary Kirschner Wire Fixation For Transverse Metacarpal Shaft Fractures: A Retrospective Review

Introduction: Fractures of the metacarpals are frequently encountered. Transverse metacarpal shaft fractures are inherently unstable and amenable to surgical intervention. Few studies have evaluated outcomes of patients with a singular transverse metacarpal shaft fracture surgically corrected with an antegrade intramedullary Kirschner (K) wire. We present our series of patients and their outcomes performed by a single surgeon. Materials and Methods: A retrospective chart review of cases at our institution was performed on transverse metacarpal fracture treated with an intramedullary K-wire. Fifteen patients met the inclusion criteria. Data extracted included metacarpal involved, laterality, sex, age, if removal of hardware was performed, time from initial injury to surgery, tourniquet time, complications, range of motion, clinical outcome, among others. Results: All fractures occurred about the right hand with 7 involving the small finger metacarpal, 4 involving the index, 3 involving the ring, and 1 involving the middle. The average patient age was 25 years (range: 18 to 58 y). The average tourniquet time was 16 minutes (range: 10 to 20 min). There were no intraoperative complications and 1 patient had hardware removed at 8 weeks due to proximal pin site pain. All patients achieved clinical union with a return of full function. Discussion: Single antegrade intramedullary K-wire fixation is a simple, reliable, and potentially cost-effective treatment option for transverse metacarpal shaft fractures. Further research is needed to determine long-term outcomes and formal cost analysis. Our series indicate this technique can be safely utilized, with a low risk of complications and good clinical outcomes. Level of Evidence: Level IV—therapeutic.

Prognostic factors for postoperative complications after K-wire fixation for paediatric forearm fractures: a multivariate analysis.

Although osteosynthesis using K-wires is a commonly performed procedure, the outcome is not always preferable. We aimed to identify the prognostic factors for postoperative complications in paediatric patients with both-bone forearm fractures. We reviewed 160 paediatric patients who underwent K-wire osteosynthesis for either distal or diaphyseal forearm fractures. We defined the occurrence rate of postoperative complications as the primary outcome and performed a multivariate logistic regression analysis. Variables such as age, sex, mechanism of injury, presence of an open fracture, ulnar or radial fracture and the associated procedure, the K-wire tip procedure and operation time, the duration from injury to operation and operation to implant removal, and duration of casting were included into the model as possible prognostic factors. The mean follow-up period was 51.2 weeks. The total number of complications was 43 (26.2%). Results of the logistic regression analysis indicated that a shorter duration from surgery to K-wire removal caused a significantly higher rate of postoperative complications [odds ratio (OR), 0.99; 95% confidence interval (CI), 0.97-1.0]. The subgroup analyses revealed that intramedullary K-wire fixation for radial fractures (OR, 1.07 × 10-5; 95% CI, 5.46 × 10-10 to 0.211) and a longer casting duration (OR, 0.84; 95% CI, 0.72-0.99) resulted in fewer postoperative infections. An exposed wire tip in the ulna contributed to more postoperative displacement (OR, 6.87; 95% CI, 1.76-26.9). To decrease the risk of postoperative complications, surgeons should bury the wire tip beneath the skin to facilitate a longer duration of K-wire placement.

Comparative Study between Intramedullary K-wire Fixation Versus Transverse Pinning in Fifth Metacarpal Neck Fracture

Background: Fifth metacarpals and phalangeal fractures are common, and neck fractures of the fifth metacarpal is the commonest. Improper treatment is associated with negative economic impact due to its associated disabilities. Aim of the work: To compare between intra-medullary and transvers K-wires for fifth metacarpal neck fractures. Patients and Methods:Thirty patients with 5th metacarpal neck fracture were included. Fifteen treated by intramedullary k-wire fixation, and fifteen treated by transverse k-wire pinning. Preoperatively, patients were evaluated by clinical, radiological and laboratory studies. Postoperatively, they were assessed clinically and by imaging studies. Objective assessment had been achieved by the total active range of motion [TAM] and hand-grip strength. Results: Both groups were comparable as regard to patient and injury characteristics. Punch was the most common mechanism of injury. The right side was affected in 80%, and the transverse fracture was the most common [reported in 53.3%]. Finally, outcome was slightly better in group 1, except for one patient of non-union. The results based on TAM% were excellent, good, fair and poor among 60.0%, 26.7%, 6.7% and 6.7% in group 1, compared to 83.3%, 40.0%, 0.0% and 6.7% in group 2 with the same order. The time to union ranged between 6 and 14 weeks. Finally, complications were reported in 20% of group 1 and 33.3% of group 2. Conclusion: Intramedullary K-wire Fixation and Transverse Pinning provide an optimal treatment options for Fifth Metacarpal Neck Fracture. Intramedullary K-wire Fixation provide slightly better outcome. However, the superiority is not statistically significant.

Humeral shaft fractures treated by closed retrograde intramedullary kirschner wire fixation

Context: Flexible intramedullary nails have been reported to provide a stable humeral fixation with satisfactory results in terms of union and complications. In this study, Kirschner wire (K-wire) was used to achieve a closed intramedullary fixation of humeral shaft fractures. Subjects and Methods: This study included forty cases of the displaced diaphyseal fracture of the humerus based on inclusion and exclusion criteria. The study was done at Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, between the periods January 2003 and November 2006. All the cases were operated after clinical evaluation. The final evaluation of the result was done by Qidwai's clinical and radiological criteria. Results: A total of forty cases were available for the study. K-wire of different sizes was used; the average duration of surgery was 45.3 ± 7.2 min. The average time taken for radiological union was 12.1 ± 1.9 weeks. The patients were analyzed by Qidwai's criteria and had excellent result in 30 (83.3%) cases, good in 4 (11.1%) cases, and poor in 2 (5.6%) cases. Three patients were lost to follow-up, and one patient was died due to medical illness. Conclusion: Intramedullary K-wire fixation is a satisfactory, safe, simple, minimally invasive technique and cost-effective treatment for humeral shaft fractures. It gives elastic mobility and stability.

K-Wire Fixation of Metacarpal and Phalangeal Fractures: Association Between Superficial Landmarks and Penetration of Structures Surrounding the Metacarpophalangeal Joint

Purpose There is little information regarding the starting points for intramedullary K-wires and their effect on the soft tissues surrounding the metacarpophalangeal (MCP) joint. This study attempted to identify starting points for intramedullary K-wire fixation and determine the effect of these K-wires on soft tissues surrounding the MCP joint. Methods We placed intramedullary K-wires in the index, middle, and little finger metacarpals and proximal phalanges in 6 cadaveric specimens. We measured the starting points of the K-wires and performed dissection to evaluate which structures were penetrated. A Fisher exact test determined statistical significance between K-wire penetration of soft tissue structures and the starting point for K-wires. Results Metacarpal K-wires started 8.5 ± 1.5 mm volar to the dorsal aspect of the metacarpal head, 19.1 ± 4.6 mm proximal to the digital palmar crease, and 8.6 ± 1.2 mm from the metacarpal head midline. All MCP K-wires crossed at least one soft tissue structure about the MCP joint; the most commonly the sagittal band. Proximal phalanx K-wires started 8.9 ± 2.9 mm proximal to the distal aspect of the metacarpal head, 25.5 ± 5.9 mm proximal to the digital palmar crease, and 9.9 ± 1.5 mm from metacarpal head midline. All proximal phalanx K-wires crossed at least one soft tissue structure about the MCP, most commonly the joint capsule. No relation was established between K-wire start point and penetration of soft tissue structures. Conclusions Use of these measurements may aid the physician in placing intramedullary K-wires into the proximal phalanges and metacarpals. Starting points that decrease the rate of penetration of soft tissue structures around the MCP joint have not been described, and all pins crossed at least one soft tissue structure adjacent to the MCP joint. Type of study/level of evidence Therapeutic IV

Intramedullary K-wire fixation: A feasible and effective technique in treatment of pediatric distal radius fractures

In this research we aimed to report the clinical and radiological results of a retrospective study performed on 6 children with severely displaced distal radial metaphyseal and diametaphyseal fractures, who were treated with percutaneous intramedullary Kischner wire (K-wire) fixation. A total of 6 children with distal unstable radius fractures, all of whom have visible physeal plate, were treated as an inpatient at our clinic January 2016 to June 2017. The average age was 8 years (range, 7–9 years). The fractures were fixed with two percutaneous intramedullary K-wires of 1.5-2 mm in diameter either transepiphyseally in three of them or both transepiphyseally and transcortically in the remaining three. Operative and short follow-up outcomes were assessed. The average operation time was 20 min (range, 15-25 min). Additional below-the-elbow splint was used in all cases for 3 weeks postoperatively. K-wires were removed after 6 weeks in all cases. Bone union was achieved at an average time of 4 weeks (range, 3-6 weeks) in all cases. No complication including malunion or early epiphyseal closure of the distal radius was identified at mean follow-up of 13 months (range, 4-18 months). Results of this study showed that reduction and osteosynthesis of distal displaced radius fractures in children by percutaneous flexible intramedullary K-wire fixation technique have many advantages regarding the maintenance of the stable construct with easy, minimally invasive and quick application. We thought that this method is a reliable treatment option for pediatric distal unstable radius fractures.

Antegrade Percutaneous Intramedullary Fixation Technique for Metacarpal Fractures: Prospective Study on 150 Cases.

The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible. Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing. Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction. Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.

Embrochage à foyer fermé antérograde pour les fractures des métacarpiens – étude prospective sur 150 cas

The aim of the study was to asses the results of antegrade percutaneous intramedullary K-wire fixation, for unstable displaced metacarpal fractures in a large number of cases in order to support the usage of this mini invasive technique in the largest variety of fractures as possible. One hundred and fifty patients with 165 metacarpal fractures were evaluated. Average follow-up 10 weeks. TAM of the digit, rotational deformity, Q-DASH score and PRWHE score were recorded. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal. Regional anesthesia, fluoroscopic guidance and upper arm tourniquet were always used. Once the metacarpal fracture was reduced, a hole at the proximal epiphiseal dorsal corner was performed percutaneously with a pointed tip K-wire (2 mm of diameter) with an incidence of about 40°. Then, a blunt tip K-wire, was inserted through the hole in the metacarpal bone in the anterograde direction along the whole intramedullary canal until the internal cortical bone of the metacarpal head, in order to obtain a stable fixation. Number and diameter of the K-wire depend on the fracture morphotype and on the size of medullary canal. They were selected to fit in the intramedullary space well to supply maximum fracture stability, verified with dynamic test. The wires were bent approximately of 90° to be perpendicular to the dorsal skin and then cut to about 2 cm outside of it to prevent tendon impingement, which is possible with subcutaneous wire cutting. A soft dressing was applied for all the patients, encouraged to begin full motion exercises. At 5 weeks the wires were removed. Few precautions distinguish our technique over others described in the literature, but they are crucial in our opinion. Percutaneous antegrade approach without joint transfixation and tendon exposition joined to an immediate finger motion is able to avoid stiffness and tendon adhesions. The thickness of K-wires is always the largest possible to ensure rotational and length stability. Do not cut the wire under the skin, prevents tendon irritations and this leads to a very low incidence of complications such as infection, algodystrophy and need for second operations. This technique represents a valid solution for the treatment of many kind of displaced and unstable fractures of the metacarpals, being of fast running, of low cost and offering excellent results both in terms clinical and radiographic.