Intramedullary Kirschner Wire Research Articles

Radiographic Results After Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus Deformity

The goal of the study was to evaluate the short-term radiographic results and complications of a percutaneous distal metatarsal osteotomy for hallux valgus. From June, 2005, until October, 2005, a percutaneous distal first metatarsal osteotomy was performed in 13 consecutive patients. All patients had mild to moderate hallux valgus deformities preoperatively. The mean postoperative followup was 130 (range 50 to 207) days. The radiographs were reviewed for hallux valgus angle, 1-2 intermetatarsal angle, nonunion, malunion, and osteonecrosis. The mean 2 weeks postoperative hallux valgus angle demonstrated a statistically significant (p < 0.0001) improvement from 25 (16 to 33) degrees preoperatively to 5 (-1 to 12) degrees postoperatively. Nine patients (69%) demonstrated dorsally angulated alignment of the first metatarsal at the first postoperative examination averaging 10.8 (6 to 15) degrees that increased to 15.9 (10 to 22) degrees at final followup. One patient developed cystic changes within the metatarsal head consistent with osteonecrosis. One patient developed a nonunion with no evidence of radiographic healing at most recent followup of 180 days. Five patients (38%) had recurrent hallux valgus defined as a final angle of greater than 15 degrees. Percutaneous distal metatarsal osteotomy for hallux valgus is associated with an unacceptable rate of complications, specifically, osteonecrosis, nonunion, malunion, and recurrence. The intraoperative correction was routinely lost after removal of the intramedullary Kirschner wire, leading to a high rate of recurrence of hallux valgus deformity as well as dorsal elevation of the capital fragment.

External Fixation With or Without Supplementary Intramedullary Kirschner Wires in the Treatment of Distal Radial Fractures

External Fixation With or Without Supplementary Intramedullary Kirschner Wires in the Treatment of Distal Radial Fractures

External Fixation With or Without Supplementary Intramedullary Kirschner Wires in the Treatment of Distal Radial Fractures

External Fixation With or Without Supplementary Intramedullary Kirschner Wires in the Treatment of Distal Radial Fractures

Simultaneous Fractures Involving The Metacarpal, Proximal And Distal Phalanges Of The Thumb Ray

Fractures of the hand are a common injury. We report the case of a forty year old man who sustained three separate fractures of his right thumb, following a fall. One of the fractures required stabilisation with 2 kirschner wires. He made a full recovery. Such an uncommon injury reemphasizes the need for a holistic approach to hand injuries. INTRODUCTION Fractures of the hand are a common injury. We report a rare case of simultaneous fractures of the metacarpal, distal and proximal phalanges of the thumb ray. CASE REPORT A forty year old right handed male presented with a swollen right hand after coming off a bike. Examination revealed diffuse swelling, bruising and tenderness over first metacarpal, proximal and distal phalange with a laceration at the base of the nail without any distal neuro-vascular deficit. Radiographs showed fractures of the first metacarpal, head of proximal and distal phalanges of the thumb (figure 1). Figure 1 Figure 1: Antero-posterior and lateral radiographs of the right hand showing fractures of the first metacarpal, proximal and distal phalanges of the first ray He had extensive debridement of the wound, primary closure of the laceration and stabilization of the fracture of the first metacarpal with two 1.6mm Kirschner wires (figure 2). Thumb spica was applied for 3 weeks. A full functional recovery followed. Figure 2 Figure 2: Post operative radiograph showing fixation of the first metacarpal fracture with two 1.6mm Kirschner wires Simultaneous Fractures Involving The Metacarpal, Proximal And Distal Phalanges Of The Thumb Ray 2 of 3 DISCUSSION Multiple finger fractures involving phalanges or metacarpals of adjacent rays have been described in the literature1. There has been no reported case of injury involving more than two bones of the same ray following a fall. Hove LM in the series of one thousand consecutive fractures involving hand reported that the fractures of metacarpals and phalanges accounted for 36% and 46% respectively2. Liew and colleagues have reported that metacarpal fractures can be treated with k-wires with good functional result3. Multiple fractures involving phalanges and metacarpals of the same ray are very rare. This case emphasizes the need to carefully exclude fractures of the adjacent bones of the same ray. CONCLUSION Multiple fractures involving phalanges and metacarpals of the same ray are very rare. This case emphasizes the need to carefully exclude fractures of the adjacent bones of the same ray. CORRESPONDENCE TO Mr R Botchu 5 Magnolia House Springwood Close Maidstone ME16 9PB Ph 0044 7967505057 Email – drbrajesh@yahoo.com

Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children

The management of chronic osteomyelitis requires the excision of necrotic and infected material followed by the prolonged administration of antibiotics. Sequestrectomy may be required before an involucrum has formed, resulting in a longitudinal bone defect. This can be difficult to fill. Vascularised grafts are complicated by a high rate of recurrent infection and thrombosis. We have managed defects of long bones in children after sequestrectomy by the use of non-vascularised fibular grafts harvested subperiosteally and held by an intramedullary Kirschner wire. Eight children underwent this procedure. In six the tibia was involved and in one each the humerus and radius. One patient was lost to follow-up. Six grafts united at both ends within 12 weeks. The seventh developed an infected nonunion distally which united after further debridement. One patient required a further sequestrectomy which did not compromise union. We have found this to be a straightforward technique with reliable results and were able to salvage the limb in all the seven patients who were reviewed.

Treatment of femoral shaft fractures in children using intramedullary Kirschner wire pinning

From 1996 to 2002 we used intramedullary Kirschner wires to treat 19 femoral shaft fractures in 19 children (11 boys, 8 girls). Their ages ranged from 2 to 13 years (mean 5.8 years). The mean follow-up time was 3 years (range 4 months to 4 years 9 months). The technique was intramedullary pinning using a 2.5- to 3.0-mm Kirschner wire introduced through the greater trochanter followed by spica casting. All cases achieved bone union within 3 months. The mean angular deformity was 1.7° (range 0°-5°), and one patient had an external rotational deformity. The mean overgrowth was 7.5 mm, but no patient had residual problems during activities of daily living. Our method has the following advantages: no need of traction, leaving bed earlier, ease of nursing, fewer radiographic examinations, less angular deformity. It also has several disadvantages: the need for an operation under general anesthesia, the need for metal removal, and an operation scar. This method can be considered as one option for treating femoral shaft fractures in children.

Successful Treatment of Buerger's Disease with Intramedullary K-wire: The Results of the First 11 Extremities

Objective This study describes a new technique for treatment of Buerger's disease, developed to stimulate angiogenesis, using a Kirschner wire placed in the medullary canal of the tibia. The aim of the study was to evaluate clinical and radiological effects of this technique in patients where medical and surgical therapy had failed. Material and methods Eleven extremities (six patients) with Buerger's disease were treated with the intramedullary Kirschner wire technique. Inclusion criteria were chronic critical ischemia, Rutherford Grade II or III, with major arterial occlusion shown by Doppler examination and angiography; failure to respond to non-surgical and surgical treatment; and the need for strong analgesics. Results The mean follow-up time was 19 months (range, 13–25 months). Satisfactory remission in each patient was obtained within 6 weeks of intervention. A significant improvement in clinical manifestations including reduced rest pain and increased claudication distance was observed. Foot ulcers completely healed after Kirschner wire intervention. Conclusion Despite short-term follow-up and small patient series, the intramedullary Kirschner wire technique can be expected to achieve relief of pain and a decrease in major amputations in patients with Buerger's disease in whom medical and surgical therapy had failed. However, comparative studies with longer follow-up should be done to confirm the benefits of this new treatment.

Promotion of fracture healing by vitamin E in rats.

We investigated the effects of the antioxidant alphae-tocopherol on early- and late-phase fracture healing in a rat model. Sixty male Sprague-Dawley rats were randomized into two groups. The right tibia of each rat was fractured manually under anaesthesia, and fracture sites fixed with intramedullary Kirschner wires. The alpha-tocopherol group received 20 mg/kg alpha-tocopherol intraperitoneally; the control group received intraperitoneal saline injections. Ten rats from each group were sacrificed on day 15, day 45 and day 60. In the alpha-tocopherol group, malondialdehyde concentrations, a measure of lipid peroxidation associated with oxygen free radicals, were significantly decreased on day 15 and day 45 compared with the control group, but had regained the 15-day value on day 60. On histopathological and radiological assessment, fracture healing on day 60 was significantly more advanced in the alpha-tocopherol group. We conclude that alpha-tocopherol has a positive effect on both early and late-phase fracture healing, and may be beneficial in clinical fracture

Arthrodesis of the toe joints with an intramedullary cannulated screw for correction of hammertoe deformity.

Twenty-four patients (37 feet, 51 toes) affected by hammertoe deformity of the lesser toes and treated surgically by arthrodesis of the proximal interphalangeal joint, stabilized with an intramedullary titanium cannulated screw, were reviewed 1-4 years after the operation. At follow-up, the arthrodesis was fused in 48 toes; three toes showed an asymptomatic radiographic nonunion, and in one of them the screw was broken. In seven toes, the cannulated screw was removed because of persistent pain at the tip of the toe where the head of the screw was located. In one case only, there was a late infection, with toe malalignment. All the patients were able to use street shoes 2 weeks after surgery. The average AOFAS score at follow-up was 86.54 points. Compared to the conventional temporary stabilization with an intramedullary Kirschner wire, the stabilization with a cannulated screw decreases the risk of infection, of radiographic nonunion, and of mallet toe deformity.

Percutaneous transphyseal intramedullary Kirschner wire pinning: a safe and effective procedure for treatment of displaced diaphyseal forearm fracture in children.

Percutaneous transphyseal intramedullary Kirschner wire (K-wire) fixation was performed for diaphyseal fracture of the forearm in 84 children. In 60 patients (71%) closed reduction was performed, while in the remaining 24 (29%) closed reduction was supplemented with a mini-open reduction The K-wire was inserted transphyseally through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. With an average follow-up of 70 months and a minimum follow-up of 2 years, all the patients reviewed were found to have good functional results; none had nonunion, deep infection, or premature physeal closure. Moreover, initial preoperative translation of the fracture of more than 100% displacement was found to be associated with a significantly higher chance of requiring a mini-open reduction. The authors concluded that percutaneous transphyseal intramedullary K-wire pining for forearm diaphyseal fracture in children is a convenient, effective, and safe operation, without any deleterious effects on subsequent growth of the distal radius.

Percutaneous Transphyseal Intramedullary Kirschner Wire Pinning: A Safe and Effective Procedure for Treatment of Displaced Diaphyseal Forearm Fracture in Children

Percutaneous Transphyseal Intramedullary Kirschner Wire Pinning: A Safe and Effective Procedure for Treatment of Displaced Diaphyseal Forearm Fracture in Children

A displaced fracture of the neck of the radius with diaphyseal fracture of ipsilateral radius and ulna in a child

A fracture of the neck of radius in children is relatively rare. The outcome is dependent not only on the injury but also on the method of treatment and presence of associated injury. We report a case of fracture of the neck of radius with complete separation of radial head associated with ipsilateral diaphyseal fractures of radius and ulna. The fracture of the neck and the shaft of the radius was treated by closed intramedullary Kirschner (K) wire, while fracture of shaft of the ulna was fixed internally by a plate and screws.

Bone-lengthening for symbrachydactyly of the hand with the technique of callus distraction.

Bone-lengthening in the hand and foot is a relatively new application for distraction osteogenesis. We present the operative treatment and postoperative outcome for four patients with M ller type-D symbrachydactyly of the hand who underwent metacarpal lengthening with use of a distraction device to establish pinch function. Four patients who underwent distraction osteogenesis for the treatment of congenital symbrachydactyly of the hand were evaluated over a thirteen-year period. The nondominant right hand was treated in two patients, and the nondominant left hand was treated in the other two. The patients included three boys and one girl; all patients had the operation between the ages of five and eleven years. Distraction osteogenesis was performed on the fifth metacarpal in one patient and on the fourth and fifth metacarpals in the remaining three, in whom both bones were lengthened simultaneously with use of a single device. Postoperative bone elongation was analyzed with radiographs made at the time of removal of the distractor. The sensory function of the treated fingers and any growth disturbance of the distracted bones were evaluated. The mean duration of distraction was 37.3 days (range, thirty-two to forty-nine days), and the distractor was removed at a mean of eighty-four days after surgery. The bones were lengthened by a mean of 22.3 mm (81.6% of their original length) at a rate of 0.6 mm/day. Pinch function was improved in all patients. On the basis of our limited experience, we found that distraction osteogenesis of the metacarpals was an effective technique for the establishment of pinch function. We also found that an intramedullary Kirschner wire could maintain the alignment of the osteotomized bone. Although distraction requires a longer treatment period, it is apparently more effective than bone-grafting in terms of achieving adequate bone length. Simultaneous lengthening of two metacarpals also was found to be an effective technique.

The Treatment of Shaft Fractures of the Clavicle

The classification of mid-shaft fractures of the clavicle according to Robinson has a good predicitive value and may therefore be used for the choice of treatment. The success rate of conservative treatment by a sling or a figure-of-eight bandage amounts to 95%. Healing problems are impending in the case of initial shortening or distraction by > 2 cm, > 100% displacement, or fragmentation. In these patients, open reduction and internal fixation (ORIF) should be considered. There are a huge number of other relative indications for ORIF, e.g., in open fractures, in fractures with neurovascular compromise, in bilateral fractures, etc., but such situations are extremely rare. In ORIF, plating with small, strong plates with three to four screws per fragment is recommended. In the literature, the nonunion rate in 500 plated fractures was 3.3%. The complication rate of intramedullary Kirschner wire fixation is similar, but this method has almost been abandoned.

Treatment of proximal humeral fractures by intramedullary Kirschner wires.

This study is a retrospective analysis of a case series of 41 proximal humeral fractures treated by multiple intramedullary Kirschner (K) wires. Forty-one proximal humeral fractures in patients aged 17 to 62 years were treated by closed intramedullary K-wires. There were 18 patients with the 2-part fractures, 11 with the 3-part fractures and 12 with the 4-part fractures according to Neer's classification. Patients were placed supine on the table, under general anesthesia. The arm was held vertically up by transolecranon traction, and the C-arm was kept parallel to the ground and opposite to the affected arm. A cortical window was created approximately 1.5 cm proximal to the olecranon fossa, by splitting the triceps. Under fluoroscopic control, multiple K-wires were introduced retrograde into the medullary cavity to reach the humeral head across the fracture. The wire tips were kept divergent to provide rotational stability at the fracture site. Postoperatively, the limb was supported in an arm sling. The patients were evaluated for pain, range of motion, strength, anatomic restoration, function of the involved limb, and radiographic union of fracture. An objective evaluation of the results using Neer's criteria showed 92.7% excellent to satisfactory results. Three patients developed painful shoulder-one from the 3-part and two from the 4-part fracture group. One patient from the 4-part group developed avascular necrosis of the humeral head. This surgical technique is effective for proximal humeral fractures. It is recommended for routine management of the 2-part and the 3-part fractures. For the 4-part fractures, it can be used in selected, young and active patients. An endoprosthesis is advised for the old, osteoporotic patients.

Fractures of the neck of the radius in children. Early experience with intramedullary pinning.

The treatment of fractures of the neck of the radius in children is difficult, particularly if the angulation of the fracture exceeds 60 degrees. Since 1994 we have used closed reduction and stabilisation with an intramedullary Kirschner wire in patients with grade-IV fractures according to the classification of Judet et al. In a retrospective analysis of a two-year period (1994 to 1996), 324 children with fractures of the elbow were treated in our department. Of these, 29 (9%) had a fracture of the neck of the radius; six were grade-IV injuries (1.9%). Five of the latter had an excellent postoperative result with normal movement of the elbow and forearm. One patient with a poor result had a concomitant dislocation of the elbow. Our results suggest that closed reduction and intramedullary pinning of grade-IV fractures allows adequate stabilisation while healing occurs.

Fractures of the neck of the radius in children

The treatment of fractures of the neck of the radius in children is difficult, particularly if the angulation of the fracture exceeds 60°. Since 1994 we have used closed reduction and stabilisation with an intramedullary Kirschner wire in patients with grade-IV fractures according to the classification of Judet et al. In a retrospective analysis of a two-year period (1994 to 1996), 324 children with fractures of the elbow were treated in our department. Of these, 29 (9%) had a fracture of the neck of the radius; six were grade-IV injuries (1.9%). Five of the latter had an excellent postoperative result with normal movement of the elbow and forearm. One patient with a poor result had a concomitant dislocation of the elbow. Our results suggest that closed reduction and intramedullary pinning of grade-IV fractures allows adequate stabilisation while healing occurs.

Intramedullary Kirschner wiring for tibia fractures in children.

This is a retrospective analysis of the results of 84 tibial fractures in children treated by intramedullary Kirschner wiring. Thirty were open fractures (9 grade I, 10 grade II, 8 grade IIIA, 3 grade IIIB). There were 65 boys and 18 girls with an average age of 10.23 years (range 4-15). The patient was placed supine on an orthopedic traction table. Under fluoroscopic control, two Kirschner wires (2.5-3.5-mm thick) were introduced antegrade from proximal metaphysis (level of tibial tuberosity) to distal metaphysis, one each from medial and lateral cortices. Open fractures were stabilized after meticulous wound débridement. Average time to union was 9.5 weeks (range 8-14). None developed delayed union. However, one grade IIIB open fracture progressed to infected nonunion; it healed after an autogenous bone graft. No infections were seen in closed fractures, but four superficial and one deep infection occurred in open fractures. Closed intramedullary Kirschner wire fixation for unstable or open tibial fractures in children is a simple surgical technique that produces good clinical and functional results.

Treatment of diaphyseal forearm fractures in children by intramedullary Kirschner wires.

This article presents a retrospective analysis of a case series of diaphyseal forearm fractures in children treated with intramedullary Kirschner wires (K-wires). Seventy-four diaphyseal forearm fractures in children (63 male subjects and 11 female subjects) with a mean age of 11 years (range, 4-15 years) were treated with percutaneous intramedullary K-wires. Under fluoroscopic control, a standard K-wire (diameter, 1.5-2.0 mm, depending on the age) was introduced into the distal radial metaphysis, proximal to the epiphysis. The K-wire was then advanced proximally across the fracture. For the ulna, the wire was introduced antegrade from the proximal end. The tip of the K-wire was prebent to 30 degrees to facilitate closed reduction of the displaced fracture. All fractures healed between 6 and 10 weeks with minimum complications and excellent clinical results. This surgical technique is convenient, effective, and safe for treating displaced diaphyseal forearm fractures in children.

CLOSED REDUCTION AND PERCUTANEOUS PINNING OF FRACTURES OF THE PROXIMAL PHALANX

This study reports the results of 12 unstable extraarticular fractures of the proximal phalanx treated with transarticular intramedullary Kirschner wires. Early proximal interphalangeal joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°. Objective physical assessment revealed one significant flexion contracture, one flexor tendon adhesion and one significant rotational deformity. Excellent results were observed in ten of the 12 patients.