K-wire Transfixation Research Articles

Comparative study of two different horizontal stabilisation methods in arthroscopically assisted coracoclavicular stabilisation for acute acromioclavicular joint dislocations-Good clinical outcome and no correlation to recurrent anteroposterior instability.

The hypothesis of this study was that acromioclavicular K-wire transfixation is noninferior to horizontal FiberTape cerclage in terms of vertical and horizontal stability in the short follow-up period of acute acromioclavicular joint (ACJ) dislocations fixed with an arthroscopically assisted coracoclavicular single bundle endobutton cerclage system. The secondary aim was to investigate the impact of postoperative recurrent instability on clinical outcomes in these populations. In this consecutive clinical trial, all patients who underwent surgery for acute AC joint dislocation between January 2017 and December 2021 were included. Two groups were formed according to the additional AC stabilisation technique (K-wire group, cerclage group). Clinical examination and bilateral radiologic analysis (Zanca stress view, Alexander view) were performed with a follow-up period of at least 12 months. Satisfaction, return to sports, active range of motion, global shoulder scores and specific shoulder scores including constant score, disabilities of the arm, shoulder and hand (DASH) score and ACJ instability score (ACJI) were evaluated. Complications, including recurrent instability, and revision rate were assessed. Included were 59 patients (32 K-wire group, 27 cerclage group, 92% male, median follow-up 33 months). No significant differences were found in the clinical outcome parameters between the different techniques, except for the DASH value (superior in the K-wire group). Recurrent anteroposterior instability was radiographically detected in 27% of patients. No correlation was found between anteroposterior instability and clinical outcome parameters. There was no revision surgery due to chronic ACJ instability. Horizontal ACJ stabilisation with temporary K-wire transfixation does not appear to be inferior to a FiberTape cerclage technique in acute ACJ dislocations stabilised in an arthroscopically assisted single bundle DogBone technique. Recurrent ACJ instability detected radiographically does not necessarily correlate with the functional outcome and can be well compensated. Level III.

Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done. Therefore, it was investigated whether anatomical reduction would best be achieved by transfixation in neutral position or supination of the forearm. Twelve cadaveric upper limbs were examined before dissection of the DRUJ stabilizing ligaments and after closed transfixation in both positions by C-arm cone-beam CT. Whether this was first done in neutral position or in supination was randomized. The change in the radioulnar ratio (RR) in percentage points (%points) was analyzed using Student's t-test. RR was used since it is a common and sensitive method to evaluate DRUJ reduction, expressing the ulnar head's position in the sigmoid notch as a length ratio. The analysis showed an increased change in RR in neutral position with 5.4 ± 9.7%points compared to fixation in supination with 0.2 ± 16.1%points, yet this was not statistically significant (p = 0.404). Neither position leads to a superior reduction in general. However, the result was slightly closer to the anatomical position in supination. Thus, transfixation of the DRUJ should be performed in the position in which reduction could best be achieved and based on these data, that tends to be in supination. Further studies are necessary to validate these findings and to identify influential factors.

Temporarily Transfixation of the distal interphalangeal Joint in Mallet fingers

This retrospective, unicenter cohort study analyse the clinical and subjective results following temporarily K-wire transfixation of the distal interphalangeal joint (DIPJ) in hyperextension in Mallet fingers. By means of a self-designed questionnaire demographic data, patient´s satisfaction (0 = unsatisfied, 10 = very satisfied), persisting pain (yes/no), postoperative complications, and the Quick-DASH score were evaluated. In addition, range of motion of the DIPJ was measured with use of a self-designed template for self-evaluation by the patients. Questionnaire and template were send to 132 patients in whom a Mallet finger was treated between January 2009 and December 2019 with K-wire transfixation of the DIPJ. 65 (49,2 %) questionnaires and templates from 40 men and 25 women with an average age of 53.3 years returned. There were 40 acute and 25 chronic Mallet fingers in 35 (54 %) middle, 19 (29 %) small, 10 (15 %) ring, and 1 (2 %) index fingers. The extension deficit was classified according to Crawford. According to the Crawford classification, there were 75 % excellent, 14 % good, and 11 % satisfied results. With an average of 7,9 points the patients were very satisfied. 15 patients reported about complications with six complaining persisting pain. The Quick-DASH score averaged 5.4 points. The treatment of Mallet fingers by transfixation of the DIPJ using a K-wire is an appropriate method leading to a good.

The influence of K-wire transfixation on proximalization of the first metacarpal after resection suspension interposition arthroplasty

IntroductionOsteoarthritis of the first carpometacarpal joint is a common degenerative disease and surgical treatment includes resection suspension interposition arthroplasty (RSIA) with or without temporary transfixation of the first metacarpal. One major drawback includes proximalization of the first metacarpal during the postoperative course. Specific data comparing different transfixation techniques in this context is sparse.Materials and methodsIn this retrospective study, we measured the trapezial space ratio (TSR) in 53 hands before and after RSIA to determine the proximalization of the first metacarpal depending on the type of Kirschner (K)-wire transfixation. We, therefore, compared transfixation of the first metacarpal to the scaphoid with one K-wire (1K) to transfixation of the first metacarpal with two K-wires (2K), either to the carpus (2Ka), or to the second metacarpal (2Kb), or to both second metacarpal and carpus (2Kc).ResultsWhile preoperative TSR did not differ between group 1K and 2K (p = 0.507), postoperative TSR was significantly higher in group 2K compared to 1K (p = 0.003). Comparing subgroups, postoperative TSR was significantly higher in group 2Kc than 1K (p = 0.046), while we found no significant difference comparing either group 2Ka or 2Kb to 1K (p = 0.098; p = 0.159). Neither did we find a significant difference within 2K subgroups, comparing group 2Ka and 2Kb (p = 0.834), 2Ka and 2Kc (p = 0.615), or 2Kb and 2Kc (p = 0.555).ConclusionsThe results of our study suggest that transfixation with two K-wires should be preferred to transfixation with one K-wire after RSIA. Specifically, transfixation from first to second metacarpal and from first metacarpal to carpus resulted in least proximalization of the first metacarpal postoperatively.

Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation

Background: Kirschner’s wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires (33.2 ± 2.7 vs. 31.3 ± 3.4, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate. (Clin Shoulder Elbow 2014;17(4):159-165)

Verletzungen des Sattelgelenks und posttraumatische Rhizarthrose

Precise function of the hand is crucially characterized by opposition movement of the thumb, only possible because of the functional anatomy of the first carpometacarpal joint. High functional demands to this joint consequently lead to the highest rate of osteoarthritis of the hand joints and loss of function. Carpometacarpal (CMC) osteoarthritis of the thumb is rarely seen in posttraumatic cases. It can be caused by fractures involving the joint surfaces of both, the trapezium or the first metacarpal, whereas dislocations of the carpometacarpal joint itself only occasionally lead to osteoarthritis. Identification and compilation of current concepts in diagnosis and therapy of posttraumatic carpometacarpal osteoarthritis of the thumb. Selective PubMed and Cochrane review, data obtained from own patient investigations and author's experiences were used. Adequate treatment of the injury will minimize the risk for future malfunction. In early stages, arthroscopy is a valuable method for the diagnosis and treatment of posttraumatic rhizarthrosis. For all stages, a multitude of operative procedures are described and being used but yet not finally assessed for effectiveness. Advanced osteoarthritis of the first CMC joint is widely treated by trapeziectomy, which is suitable for most patients, and considered as gold standard. Additional procedures like suspension, interposition or k-wire transfixation do not provide any significant advantage and lead to comparable results. It is advisable to treat hyperextension of the metacarpophalangeal joint of the thumb at any stage of CMC osteoarthritis.

Pinning across the Metatarsophalangeal Joint for Hammertoe Correction: Where Are We Aiming and What Is the Damage to the Metatarsal Articular Surface?

Kirschner wire (K-wire) fixation across the metatarsophalangeal joint (MTPJ) is commonly used in hammertoe repair surgery. The purpose of the present study was twofold: (1) to determine where the K-wire penetrates the metatarsal articular surface to achieve a rectus digit; and (2) to quantify the percentage of cartilage disruption to better understand the consequences of K-wire transfixation of the MTPJ. Arthrodesis was conducted on the second, third, and fourth proximal interphalangeal joints of 10 below-the-knee cadaver specimens, using a 1.6-mm K-wire. Digital alignment was confirmed with simulated weightbearing intraoperatively and radiographically. The K-wire was removed, and the MTPJ was dissected until the metatarsal head was fully exposed. The penetration point was plotted on a quadrant system with deviation noted from the epicenter. Center was defined as the point equidistant from the medial-to-lateral and superior-to-inferior edges on the distal surface of the metatarsal head, excluding the plantar condyles. Statistically significantly deviations were found in the K-wire placement from the center (35.9% ± 17.5%, p < .001), medial-to-lateral width (22.2% ± 19.2%, p < .001), and dorsal-to-plantar height (15.8% ± 25.0%, p = .002). Relative to the center, the K-wire was superior in 22 (79%), inferior in 6 (21%), medial in 22 (79%), and lateral in 6 (21%) of the cadaveric MTPJs. The mean percentage of disruption of the articular cartilage was 1.8% ± .4% and was similar for the second, third, and fourth MTPJs (p = .13) and for the left and right feet (p = .75). This information could be used to guide surgeons when they transfixate the MTPJ during hammertoe correction and might contribute to preservation of the articular cartilage.

Surgical Treatment of Fresh Complete Acromioclavicular Dislocation by Coracoid Process Transfer and K-Wire Transfixation

Acromioclavicular dislocations are very common shoulder injuries. The optimal treatment for acute high-grade acromioclavicular joint injury remains a matter of debate. The purpose of this study was to evaluate the results of surgical treatment of complete acromioclavicular dislocation using coracoid process transfer and temporary K-wire transfixation. Twenty-one patients with complete acromioclavicular dislocation underwent coracoid process transfer and temporary K-wire transfixation. Patients were assessed at the follow-up based on visual analog scores (VAS), the Constant-Murley scoring system and the UCLA shoulder rating system. Radiographs were taken to check up vertical instability. The mean follow-up was 32.1months (25-47months). The mean Constant and Murley score and UCLA shoulder rating score was 89.9 ± 8.4 and 30.1 ± 4.4. There were fourteen excellent functional results and six results and one poor result. The overall rate of satisfaction, which means an excellent or good result, was 95.2%. Nineteen patients (90.4%) maintained their previous jobs or resume their daily activities. The mean final pain score, as measured from 1 to 10 on the visual analog scale, was 1.91 ± 1.09. The radiographic analysis revealed twenty patients had maintained reduction at the final follow-up. The coracoid process transfer and temporary K-wire transfixation is a reliable treatment for a complete acromioclavicular dislocation.

Consistency of Long-Term Outcome of Acute Rockwood Grade III Acromioclavicular Joint Separations After K-Wire Transfixation

Surgical approach to acute Rockwood grade III acromioclavicular (AC) joint injuries demands satisfying and reliable treatment results of shoulder function in the long term. This study investigates the operative outcome of acute grade III AC joint separations after temporary K-wire transfixation of the AC joint over the years. We hypothesize, that the well-established temporary articular transfixation of acute Rockwood grade III AC joint dislocations with K-wires provides good and consistent functional outcome at long term. Seventy patients who underwent temporary articular transfixation of the AC joint followed by a standardized rehabilitation program and early physiotherapeutic exercising were divided into three follow-up cohorts. The treatment results were investigated 1 to 2 years (short-term, group A, n = 18), 3 to 5 years (mid-term, group B, n = 33), and 6 to 10 years (long-term, group C, n = 19) after surgical procedure. The outcome was measured using a standardized functional patient questionnaire including Constant score, ASES rating scale, SPADI, and XSMFA-D score. The results given in average and mean +/- SD were compared between the three cohorts by calculating the Kruskal-Wallis one way analysis for variance on ranks. Average patient age at time of surgical therapy was 37 (+/-11) years without significant difference between the three cohorts. Independent of follow-up period all patients demonstrated good functional treatment results in the long run expressed by an over all Constant score of 88 (+/-10) points, ASES rating scale of 29 (+/-3) points, SPADI of 3 (+/-9) points, XSMFA-D function score of 13 (+/-2) points, and XSMFA-D impairment score of 4 (+/-1) points, respectively. The comparison of the three follow-up groups proved no significant differences in outcome over a maximum follow-up period of up to 10 years. However, the longer the follow-up period, the tendency of the promising treatment outcome becomes more stable. Temporary K-wires fixation of acute Rockwood grade III AC joint separations enable good long-term results in shoulder function. The achieved functional outcome parameters reveal a high consistency in the long run over the years.

Zur chirurgischen Behandlung des Pes equinovarus als Folge eines Kompartment- und/oder Postischämiesyndroms der tiefen Flexorenloge des Unterschenkels

Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. Infected ulcers below the fifth/fourth metatarsal bone in a numb plantar sole often require head resection because of osteomyelitis.From 1994 to 2007 a total of 24 patients with severe pes equinovarus after compartment and/or postischemic syndrome were treated operatively. Only in 5 cases was a triple, Chopart, or Lisfranc arthrodesis necessary; 19 cases however could be treated only by soft tissue procedures like tenolysis, tendon lengthening, medial release of the scarred flexor retinacula and contracted capsules of the posterior ankle, subtalar and talonavicular joint to reorientate all axes of the foot. By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable.The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.

Results of Arthroscopic Reduction and Percutaneous Fixation for Acute Displaced Scaphoid Fractures

This study used percutaneous techniques augmented by simultaneous wrist arthroscopy to visualize the fracture and thus confirm the fracture alignment and reduction and also to assesses the concurrent associated ligament injuries. Retrospective study. Arthroscopy was used to help to reduce scaphoid fractures and assess soft-tissue injuries in 15 acute cases (13 male and 2 female patients). The fractures were treated by reduction under arthroscopic control and percutaneous fixation with the cannulated interosseous compression screw. Soft-tissue lesions were also treated at the same time using debridement, suture repair, or K-wire transfixation. The average age of the patients was 29.2 years (range, 19 to 48 years). Two patients (13.3%) had scapholunate (SL) ligament injuries, and both exhibited partial tear of the SL ligament. Four patients (26.7%) suffered lunotriquetral (LT) ligament injuries and received ligament debridement, K-wire fixation of the LT joint, and splinting. Six patients (40%) had chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 5 patients (33%). Finally, 5 patients (33%) suffered radioscaphocapitate ligament or long radiolunate ligament injuries. All fractures healed without malunion or nonunion and, at follow-up of 24 to 28 months, 11 patients had excellent results and 4 had good results based on Mayo Modified Wrist Scores. We believe that arthroscopic reduction may be considered for scaphoid fractures because this approach can use a single procedure to achieve acceptable restoration of fractures as well as assessment and management of soft-tissue lesions. Level IV Therapeutic Study, case series with no, or historical, control group.

Temporary Kirschner Wire Ankle Transfixation and Delayed ORIF

Immediate ORIF (open reduction and internal fixation) is the treatment of choice for displaced ankle fractures. However, definitive treatment may have to be delayed due to compromised soft tissues. The value of temporary Kirschner wire ankle transfixation with staged ORIF for closed displaced ankle fractures with tibiotalar dislocations was determined. In this retrospective case series (1997–2001), 92 patients (mean age 54 years, range 20–86 years) who underwent a staged procedure for isolated and closed displaced ankle fractures with tibiotalar dislocations were studied. Patients were primarily treated by means of immediate closed reduction. For stable fractures and adequate soft tissues a split plaster cast was applied (n = 50). K-wire transfixation was performed for unstable fracture-dislocations and/or critical soft tissues (n = 42). All patients underwent delayed ORIF after recovery of the soft tissues. In the K-wire group (KWG), local complication rate was 7%. Mean operating time was 30 min (5–65 min). In the plaster cast group (PCG), local complication rate was 10% (p = 0.72, not significant). Three redislocated ankles (6%) had to be transfixed secondarily. A higher grade of soft-tissue injuries in the KWG (p < 0.05) resulted in a longer time interval between primary treatment and staged ORIF (7 vs. 5 days; p < 0.05) and a longer hospital stay (19 vs. 17 days; p < 0.05) for the KWG. Temporary K-wire ankle transfixation is an effective method for initial treatment of closed displaced ankle fractures with tibiotalar dislocation, if ORIF has to be delayed and immobilization in a split plaster cast is not suitable. Retention is reliable with a low complication rate.

Talar dislocations

From 1987-2003, 36 patients were treated for talar dislocation, 27 patients for subtalar, six for total talar, and three patients for peritalar dislocation. Luxatio pedis sub talo: We found 19 medial closed, seven lateral closed and one third degree open subtalar dislocations. Our therapeutic concept provides for immediate reduction, which is possible by closed procedure for the majority of medial dislocations. If there is a tendency to redislocation, we perform talonavicular K-wire transfixation. In the case of irreducibility, open reduction via lateral approach is the rule. The lateral dislocation type is often accompanied by additional fractures of the hindfoot and tarsus, frequently requiring primary open procedures via medial approach. 32 patients were followed-up in whom we found 17 excellent results, ten good, three mediocre and two poor results. With two thirds of the patients, low grade arthrosis at least was observed and two thirds showed a reduced amplitude of motion in one or more talar joints. A definite correlation between arthrosis and reduced function was not established. We did not find talar necroses, persisting instabilities, or redislocations. Luxatio tali totalis: We found three lateral and three medial complete dislocations. The therapeutic concept consists of immediate reduction-only possible by open procedure. A tendency to redislocation requires K-wire transfixation. All patients were followed-up. We found two good and four poor results, with two total and three partial necroses. As a secondary treatment, two lower ankle joint(LAJ) and two upper ankle joint (UAJ) arthrodeses were performed. There were no talectomies, amputations, or infections. Luxatio pedis cum talo: We found three anterolateral UAJ dislocations. Our therapeutic concept provides for immediate reduction. The whole capsular ligament apparatus was reconstructed by primary or secondary treatment, depending on the degree of soft tissue damage. Follow-up showed two excellent results

A rare case of carpal dislocation

We present a rare case of carpal perilunate fracture-dislocation, with volar displacement of the distal carpal row and a proximal row location of the triquetrum. A pre-existing abnormal radio-luno-capitate alignment might have contributed to both the unusual volar direction and the difficulty encountered in its treatment, which caused us to perform a radiocarpal K-wire transfixation.

La reconstruction ligamentaire secondaire de la métacarpo-phalangienne du pouce (MPI)

The disruption of the ligaments at the level of the MP-joint jeopardizes the function by lack of stability. The reconstruction by free tendon grafting, anchored in a dorso-lateral plane in the metacarpal an in the proximal phalanx, restores stability and good functional results in spite of a slight amount of loss of flexion. Two out of 25 operated thumbs failed and fusion of the MP-joint was necessary. A minimal limitation of flexion may be desirable since a tendon graft never restores a full physiological function. Our data show no need for K-wire transfixation of the MP-joint, since there is no evidence of a difference in late stability with or without such additional fixation. The mean pinch-grip pressure, restored to normal in the majority of cases, was not influenced by the mentioned reduction of flexion nor by the amount of stability restored.