Kirschner Wire Research Articles

Treatment Outcome of 2nd to 5th Metacarpal Fractures: Kirschner Wires Versus Intramedullary Screws

Background/Objectives: Most metacarpal fractures are isolated, simple, closed, and stable fractures and located distally. They are often caused by accidental falls, strikes by humans, by objects or traffic accidents. The majority can be treated conservatively. When unstable, angulated, malrotated or shortened, a surgical fixation of these frequent fractures is needed. To treat simple, spiral, distal or shaft fractures, intramedullary Kirschner wiring (KW) or intramedullary compression screws (ISs) are used. We wanted to compare the outcomes of those two treatments. Methods: In a retrospective study we analyzed the prospectively collected data of our hospital on the indication factors and outcome factors of selected patients with simple or spiral, distal or shaft metacarpal fractures of the second to fifth finger. Indication factors were sex, age, profession, hand dominance, comorbidities, metacarpal finger number, total active range of motion (TAM), rotation, soft tissue damage, localization, articular involvement, fracture type, dislocation and axial shortening. Outcome factors were TAM, rotation, splint time, return to work, bone healing and complications. Results: Out of 750 patients, 59 fractures could be included in this study, containing 34 in the KW Group and 25 in the IS Group. Only fracture localization and fracture type were significantly different in the two groups, with more shaft and spiral fractures in the IS Group. The primary outcome of TAM and rotation as well as the secondary outcome of splint time, return to work, bone healing and complication rates showed no significant difference. Only a difference in mean follow-up time was seen. Conclusions: Intramedullary screw fixation seems a valid alternative to KW fixation for certain fracture types regarding active range of motion and rotation after treatment, splint time, bone healing and return to work time. Only the tendency of an earlier return to work and a higher rate of full TAM after treatment was seen in favor of intramedullary screws.

Arthroscopy combined with bone tunnel technique for treating Berndt and Harty stage III or IV osteochondral lesions of the talus.

To explore the efficacy and feasibility of arthroscopy combined with bone tunnel technique in treating Berndt and Harty stage III or IV osteochondral lesions of the talus (OLT). A retrospective analysis was conducted on the clinical data of 21 patients with Berndt and Harty stage III or IV OLT who underwent surgical treatment at our institution from September 2017 to September 2022. Under arthroscopy, the displaced talar osteochondral lesion was restored. A 2.0mm Kirschner wire (K-wire) was used to create a bone tunnel from the medial (or lateral) malleolus to the realigned osteochondral lesion. A 1.5mmK-wire was then used to drill through this tunnel into the osteochondral fragment, and a 1.5mm absorbable bone rod was inserted for fixation. Preoperative and final follow-up visual analogue scale (VAS) for pain and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were recorded and compared. All 21 patients were followed up for an average of 23.95 ± 6.01months. All wounds healed by primary intention, with no nerve, blood vessel, or tendon injuries. All osteochondral lesions healed, with an average healing time of 3.71 ± 0.62months. The VAS score decreased from a preoperative average of 5.38 ± 0.59 to 0.48 ± 0.51 at the final follow-up. The AOFAS ankle-hindfoot scale increased from a preoperative average of 56.29 ± 5.98 to 88.43 ± 2.68 at the final follow-up (P < 0.05), showing statistically significant differences. Two cases experienced medial pain after 12months, which was tolerable with non-steroidal anti-inflammatory drugs. Arthroscopy combined with bone tunnel technique for treating Berndt and Harty stage III or IV OLT has the advantages of minimal injury, visualization of fracture reduction, and fewer complications.

Seizure-related bilateral asynchronous displaced late presenting Delbet type I fractures: A case report and literature review

Delbet type I transphyseal hip fractures without dislocation are extremely rare injuries. This is the first report of a bilateral case caused by seizures. A 4-year-old girl with global developmental delay, who walks supported, fell off her bed during an epileptic fit. The parents presented two weeks later, and radiographs revealed a displaced right Delbet type I transphyseal upper femoral separation. Under general anesthesia, surprisingly, the physis was reduced anatomically using the Leadbetter maneuver. Fixation was carried out with three smooth Kirschner wires (KWs), after which uneventful healing occurred. Sixteen months following the first injury, the girl had another seizure, which resulted in a buckle fracture of her left distal femur. Unfortunately, an identical left hip physeal injury was missed. On presentation three months later, stress radiographs showed non-union of the physis. Fortunately, again, the Leadbetter maneuver succeeded in reducing the physis, which was fixed using two smooth KWs. She was seen one year following the left hip surgery (2.5 years after the right hip surgery), and the left physis had united with no ischemic necrosis on both sides. The patient then resumed her ability to walk supported and sit cross-legged. A telephone call to the father six years post-surgery to the right hip and four years and six months post-surgery to the left hip confirmed that she was asymptomatic and maintained her previous abilities. Because of the COVID-19 pandemic, she could not attend for clinical and radiographic examinations.

StraightTrack: Towards mixed reality navigation system for percutaneous K‐wire insertion

AbstractIn percutaneous pelvic trauma surgery, accurate placement of Kirschner wires (K‐wires) is crucial to ensure effective fracture fixation and avoid complications due to breaching the cortical bone along an unsuitable trajectory. Surgical navigation via mixed reality (MR) can help achieve precise wire placement in a low‐profile form factor. Current approaches in this domain are as yet unsuitable for real‐world deployment because they fall short of guaranteeing accurate visual feedback due to uncontrolled bending of the wire. To ensure accurate feedback, StraightTrack, an MR navigation system designed for percutaneous wire placement in complex anatomy, is introduced. StraightTrack features a marker body equipped with a rigid access cannula that mitigates wire bending due to interactions with soft tissue and a covered bony surface. Integrated with an optical see‐through head‐mounted display capable of tracking the cannula body, StraightTrack offers real‐time 3D visualization and guidance without external trackers, which are prone to losing line‐of‐sight. In phantom experiments with two experienced orthopedic surgeons, StraightTrack improves wire placement accuracy, achieving the ideal trajectory within mm and , compared to over 12.08 mm and 4.07 for comparable methods. As MR navigation systems continue to mature, StraightTrack realizes their potential for internal fracture fixation and other percutaneous orthopedic procedures.

The safety of humeroradial fixation using Kirschner wires in children

Humeroradial joint fixation (HJF) has been employed during elbow surgery to maintain stability. Kirschner wire (K-wire) fixation is the most commonly used method in children; however, there are valid concerns regarding complications such as breakage. In this study, we retrospectively analyzed the safety of humeroradial fixation using K-wires in children. In total, 249 patients diagnosed with Monteggia fractures underwent HJF at our institute from January 2013 to November 2021. All relevant clinical data were collected after applying the inclusion and exclusion criteria. Skin irritation, incision infection, elbow instability, and ulnar healing were followed up. The elbow function was evaluated using Mackay standards. There were 81 females and 168 males (average age, 6.6 ± 2.8 years). Of these patients, 67 did not have ulna fixation, whereas 127 were fixed with K-wires after osteotomy of the proximal ulna or correction of the deformity. The K-wire sizes used for HJF were 1.6, 1.8, and 2 mm in 6, 125, and 118 patients, respectively. The duration of K-wire fixation of the humeroradial joint was 6.6 ± 2.5 weeks on average. Two patients suffered from K-wire breakage and underwent reoperation. There were three patients with K-wire end irritation. According to Mackay standards, the elbow function score was excellent, good, and poor in 188, 41, and 20 patients, respectively, at 6 months postoperatively. No bone bridge was found at the capitellum and radial head fixation sites in any patient. HJF using K-wires combined with a cast is a safe method with a low incidence of complications in children and should be considered a reliable option when humeroradial joint fixation is required.Level of evidenceIV.

Revisiting Antibiotic-Impregnated Cement Spacer for Diabetic Osteomyelitis of the Foot

Introduction: Despite the rising global awareness and improvement of socioeconomic and living standards, the prevalence of diabetic osteomyelitis (DOM) and its complications has been increasing rapidly. This study aims to investigate the long-term prognosis of DOM of the foot treated using antibiotic-impregnated cement spacer (ACS) and the contributing risk factors for reoperation. Methods and Materials: We retrospectively reviewed the data of 55 diabetic patients with Meggitt-Wagner Grade IIB wounds diagnosed with osteomyelitis of the foot, treated in our institution with excessive debridement, excision of the infected tissue, and implantation of antibiotic-impregnated cement spacer fixed with a Kirschner wire. Descriptive statistics, including patient demographics, were analyzed. Statistical analysis was performed using point-biserial correlation and a Chi-square test with Cramer’s V effect-size estimation to determine the relationship between reoperation and various parameters. Results: 55 patients (36 (65.45%) males and 19 (34.55%) females) with a median age of 64 (39–84) years were thoroughly analyzed throughout a median follow-up of 884 days (2–4671 days). Of the entire cohort, 29 (52.72%) patients achieved primary successful infection eradication without any further intervention, and 8 (14.54%) patients were successfully treated using a secondary procedure. More than half of the reoperated patients underwent the secondary intervention within less than a month after the primary ACS. When assessing correlation, age (r = 0.28, p = 0.04), gender (r = 0.31, p = 0.02), Staphylococcus aureus (r = −0.10, p = 0.04), and the use of gentamicin-only antibiotic cement spacer (r = 0.34, p = 0.01) demonstrated statistically significant correlation to reoperation. 89.18% of the patients who achieved infection eradication did not undergo cement removal. Conclusions: ACS has shown excellent results in eradicating bone infection with up to 7.23 years of follow-up, acting as a structural stabilizer, preventing soft tissue contractures, and delivering highly concentrated local antibiotic treatment both to soft tissue and bone. Regardless, specific factors should be thoroughly evaluated prior to surgery, as advancing age, gender, and the use of gentamicin-only antibiotics appear to be positively associated with a higher likelihood of reoperation. Conversely, infections caused by cultured Staphylococcus aureus seem to be inversely related to reoperation.

The Rule of Fours-Clinical and Radiographic Parameters for Trans-articular Distal Interphalangeal Joint Kirschner Wire Insertion.

Distal phalangeal and interphalangeal joint injuries are common, and confer a significant burden to the individual, healthcare system and society. Operative intervention (when required) may involve retrograde trans-articular Kirschner wire (K-wire) fixation. Safe wire passage through the center of the distal interphalangeal joint (DIPJ) and associated phalanges is key in maintaining alignment and reducing complications. There is little evidence to guide optimal wire entry point and passage. The aim of this study was to determine soft tissue and radiographic landmarks to guide optimal trans-articular k-wire placement at the DIPJ. A retrospective cohort study was conducted at a single institute, with 100 uninjured lateral phalangeal radiographs with a clear sagittal projection assessed by 3 independent assessors. Each assessor drew a line of ideal insertion, traversing the isthmus of the middle and distal phalanges, and the midline of the DIPJ, with soft tissue and bony parameters identified. The mean distance from the dorsal aspect of the nail plate to the line of ideal insertion was 3.86 mm, with a disparity between sexes noted. The distance from the dorsum of the soft tissue to the line of ideal insertion was expressed as a proportion of the total soft tissue diameter-the line of ideal insertion traversed approximately 40% of total width at the DIPJ and DIPJ soft tissue crease. The results suggest that a simple 'rule of fours' can be utilized to allow expedient and optimal passage. The entry point should be midline in the coronal plane, approximately 4 mm volar to the dorsal surface of the nail plate and aimed at a point 40% volar to the dorsal aspect of the soft tissue envelope at the level of the DIPJ crease. These guidelines are easily replicable and conveyable; additionally, they can guide insertion in the absence of fluoroscopy.

Intraoperative angulation of the C-arm for X-ray of each curved surface of the femoral neck wall: a cadaveric study.

C-arm fluoroscopy is the main method assisting surgical reduction and internal fixation of the femoral neck, as traditional anteroposterior and lateral fluoroscopy is insufficient for visualizing the irregular anatomical structure of the femoral neck. We analysed the anatomy of the femoral neck to ascertain the optimal position and angle of the C-arm for adequate visualization of the femoral neck during fluoroscopy. The femoral neck was divided into anterior, posterosuperior and posteroinferior surfaces. These surfaces and the coronal plane of the femur formed the anterior surface coronal angle (ACA), posterosuperior surface coronal angle (PSCA) and posteroinferior surface coronal angle (PICA), respectively. Three angles of 32 dried femoral samples were measured. In the aluminium model, steel wires penetrated the femoral neck wall, whereas, in the wire model, three Kirschner wires penetrated the femoral neck wall. The C-arm was rotated 5° for a 0°-180° fluoroscopic view of each curved surface. Each specimen was imaged, totalling 111 frames. The optimal angle for fluoroscopic imaging of each surface was ascertained, and fluoroscopic features of the Kirschner wire penetrating the femoral neck cortex at three different angles on fluoroscopy and anteroposterior and lateral radiographs were observed. The femoral neck is irregularly shaped and cylindrical, with the anterior surface longer than the posteroinferior surface. The ACA, PSCA and PICA were 31 ± 4.589°, 67.813 ± 5.052° and 168.688 ± 3.206°, respectively. The optimal angles for visualizing the anterior, posterosuperior and posteroinferior surfaces of the steel wire aluminium foil model under fluoroscopy were 30.781 ± 5.464°, 67.969 ± 3.721°, and 167.813 ± 4.319°, respectively. There was no significant difference in the measurements of the corresponding surface coronal angles (P > 0.05). Kirschner wires penetrating the femoral neck wall were difficult to visualize on traditional anteroposterior and lateral films. Increasing the angle to 30°, 70° or 170° for fluoroscopy allowed clear visualization of Kirschner wires penetrating the femoral cortex. Traditional anteroposterior and lateral fluoroscopic views are insufficient for clear visualization of the true structure of the femoral neck. Additionally, increasing the angle to 30°, 70° or 170° for fluoroscopy allows observation of the fracture reduction quality from the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck and the damage to the corresponding cortical bone caused by internal fixation. Level II.

Management of Acute Lateral Humeral Condyle Fractures in Children

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications.

Analysis of the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures with coracoclavicular ligament injuries

ObjectiveTo investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries.MethodsA retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery.ResultsNo significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group.ConclusionIn the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

Evaluation of 3D‐printed patient‐specific guides to facilitate fluoroscopic‐assisted Kirschner wire stabilization of simulated capital physeal fractures in 3D‐printed dog femur models

AbstractObjectiveTo compare the efficiency and accuracy of freehand and three‐dimensionally printed (3DP) guide‐facilitated fluoroscopic‐assisted Kirschner wire placement in the femoral capitis performed by novice and experienced surgeons.Sample population3DP models of five skeletally immature dog femurs were replicated.MethodsVirtual surgical planning was done to position three parallel, virtual Kirschner wires inserted from the lateral subtrochanteric surface of the femur, coursing proximomedially through the femoral neck to engage the central capitis without penetrating the subchondral bone. Patient‐specific guides were designed and 3DP to facilitate optimal Kirschner wire placement in each femoral model. Four faculty surgeons and four surgery residents performed freehand fluoroscopic‐assisted wire placement in the femoral models. Wire placement was repeated ≥1 month later using the 3DP guides. Surgical time, number of times wires were redirected, number of fluoroscopy images acquired and Likert scores from the participants were recorded. Post‐procedural CTs of the femur models were used to assess wire placement by 3D analysis.ResultsThe number of fluoroscopy images was greater (p &lt; .001) and procedure time was longer (p &lt; .001) for freehand applications, while Likert scores were greater (p &lt; .001) for 3DP‐guide applications. Wire placement was more accurate with 3DP guides. Subchondral bone penetration occurred more frequently during freehand applications (p &lt; .01).Conclusion3DP patient‐specific guides resulted in faster, simpler, and more accurate Kirschner wire placement than freehand placement for both novice and experienced surgeons. Further cadaveric and clinical studies are warranted to evaluate the utility of 3DP patient‐specific guides to facilitate minimally invasive fluoroscopic‐assisted femoral capital physeal fracture stabilization in dogs.

Biomechanical Analysis of Different K-wire Configurations for Percutaneous Fixation of Two-Part Proximal Humerus Fractures.

The increasing prevalence of proximal humerus fractures in the elderly population, particularly osteoporotic fractures, necessitates a biomechanical evaluation of Kirschner wire (K-wire) configurations used in percutaneous fixation. This study investigates the stability of different K-wire configurations and examines the effect of wire size and type (smooth vs. threaded). Using 27 synthetic humeri models, we compare three configurations as follows: four parallel ascending K-wires (box-type), two ascending and two descending K-wires, and a combination of both. Results show that adding descending K-wires significantly enhances stability, particularly against torsional forces. This study highlights the importance of wire type and configuration in stabilizing proximal humerus fractures. Multiplanar constructs with descending K-wires, especially threaded ones, offer better stability. These insights help improve surgical techniques for elderly and osteoporotic patients, but further research using cadaver models is needed for clinical validation.

Paediatric Hand Fractures - A Review.

Paediatric hand fractures account for approximately 25% of hand-related emergency department visits, making them the second most common childhood fractures after distal forearm fractures. These injuries are more prevalent in boys and peak ages between 9 and 14 years. Hand fractures in children are primarily caused by crushing injuries and, increasingly in older children, by sports-related activities. The little finger (52%) and thumb (23%) are the most frequently fractured digits, with phalangeal fractures, especially of the proximal phalanx, being common. Metacarpal fractures are more prevalent in adolescents (13-16 years) compared to younger children. Accurate diagnosis in the paediatric population is complicated by difficult clinical examinations and the presence of growth plates, leading to an 8% misdiagnosis rate, mainly due to misinterpretation of the ossification centres and physes. High-quality radiographic evaluation combined with a thorough clinical assessment is critical for correct diagnosis and appropriate management. The robust periosteum and high remodelling potential of paediatric bones allow most hand fractures to be managed non-operatively with splinting or casting. However, fractures with significant angulation, rotation, intra-articular involvement or open wounds may require surgical intervention, such as closed or open reduction and internal fixation with Kirschner wires. Most paediatric hand fractures heal well with excellent functional outcomes due to the high remodelling capacity of paediatric bones. Early mobilisation and appropriate immobilisation are key to preventing stiffness. Despite the generally favourable prognosis, certain fractures remain challenging to diagnose and treat, highlighting the need for specialised care. The aim of this review article is to discuss the epidemiology, fracture patterns, diagnostic challenges and management strategies essential for optimising functional outcomes and minimising long-term complications in treating paediatric hand fractures. Level of Evidence: Level V (Therapeutic).

Treatment of diametaphyseal forearm fractures in children and adolescents : Antegrade intramedullary nail osteosynthesis and its alternatives

Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load. Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits. Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path. In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3-4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. Atitanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending. The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8weeks. Metal removal can be performed after consolidation between 3and 6months. Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with alow risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.

Talonavicular arthrodesis

Realignment of the hindfoot by talonavicular arthrodesis. Idiopathic and posttraumatic arthritis of the talonavicular joint with or without malalignment. Optional in flatfoot reconstruction. General medical contraindications to surgical interventions. Medial, dorsomedial, or dorsal skin incision. Exposure of the talonavicular joint and cartilage removal. Decortication. Reposition of the joint if malaligned. Optional transplantation of corticocancellous bone. Temporary stabilization with Kirschner wires and stabilization with screws, optional with cramps or plates. Sixweeks nonweightbearing in along walker boot. Afterwards 2weeks of progressively weight bearing in along walker boot. Then full weightbearing in walking shoes with stiff soles. Physiotherapy. Atotal of 18feet in 18patients with isolated talonavicular arthritis were treated with isolated talonavicular fusion and corticocancellous bone thorough amidline incision. For postoperative management, patients had nonweightbearing for 6weeks in along walker boot. Mean follow-up was 14.5months (range 8-35months). Mean age was 63.2years (range 54-72years). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 65.3 (± 5.2); postoperative MOXFQ score was 28.5 (± 7.0). One revision surgery performed due to pseudarthrosis.

Kirschner wire creates more microdamage than standard or acrylic drill bits in the rabbit (Oryctolagus cuniculi) femur.

Histologically evaluate damage to rabbit femur after the creation of bicortical 1.5-mm-diameter holes using a standard surgical drill bit, an acrylic drill bit, and a Kirschner wire (K-wire). 10 femora (5 pairs) from skeletally mature female intact New Zealand white rabbits were used. The bone diaphyses were divided into 4 locations, systematically undergoing each test (surgical drill bit, acrylic drill bit, K-wire, and intact control). Four pairs were drilled using a mechanical testing machine, and 1 pair was drilled by hand. Cross-sections of the bone were stained en bloc with basic fuchsin for undecalcified histological evaluation. Damaged bone was reported as a percentage of a standardized area and categorized by location (cis- or transcortex), drill contact (entrance or exit of the cortex), and total damage (both cortices). The drilling method (hand vs mechanical testing machine) had no effect on histologic damage, so results were analyzed by combining all data. The K-wire demonstrated the greatest area of cracks/damage compared to both standard surgical and acrylic drill bits, whereas no difference in damage was noted between the 2 drill bits for all variables. The K-wire and drill bits caused microdamage; K-wire drilling created more microdamage than drill bits. The rabbit bone cortex is thin and brittle relative to dogs and cats, leading to failure during and after fracture fixation. The clinical failure of rabbit bone is at least partially caused by drill bits or K-wires causing microcracks.

Histopathological and radiological evaluation of the efficacy of hydroxyapatite–boric acid and hydroxyapatite–magnesium coated Kirschner wires on fracture healing in femoral diaphyseal fractures: an experimental study

BackgroundBiomaterials used in fracture healing hold a significant place in orthopedics. This study aimed to develop biomaterials coated with hydroxyapatite (HA), boric acid (BA), and magnesium (Mg) and investigate their effects on fracture healing.MethodsSixty female Wistar Albino rats were included in the study. The subjects were randomized into five groups. Cytotoxicity tests were performed on HA, BA, and Mg, and cell viability rates were calculated. Coatings were applied to Kirschner (K) wires at determined ratios. Group I was the control group with a steel K wire, Group II used HA-coated K wires, Group III used HA + BA-coated K wires, Group IV used HA + BA + Mg-coated K wires, and Group V used HA + Mg-coated K wires. A fracture was induced in the right femur of the subjects, followed by fixation with intramedullary K wires. The subjects were randomly divided into equal numbers and sacrificed at 6 and 12 weeks. Radiological and histopathological evaluations were performed.ResultsIn direct cytotoxicity tests, the highest viability rate was observed in Group IV, while in indirect cytotoxicity tests, it was highest in Group II. In radiological evaluation at the 6th week, the highest scores were in Groups IV and V, while the lowest was in Group III. At the 12th week, the highest scores were in Groups II and V, while the lowest was in Group I. No significant differences were found between the groups (p = 0.837, p = 0.0479). In histopathological evaluation, a significant difference was observed between the groups (p < 0.001), with the highest scores in Group V. A correlation was found between the radiological and histopathological scores (p < 0.001, r = 0.438).ConclusionIt was found that HA + Mg significantly improved histological outcomes in fracture healing. Good histological results can be achieved with the use of Mg-containing implants in both early and late-stage fracture healing. Coating the biomaterials used in fracture fixation with Mg may lead to positive outcomes in fracture healing.

OUTCOME OF BURIED VERSUS EXPOSED KIRCHNER WIRES IN TERMS OF INFECTION IN FRACTURE OF PHALANGES AND METACARPAL BONE OF HAND

Kirschner wire (K-wire) fixation is a common technique for treating phalangeal and metacarpal fractures due to its cost-effectiveness and efficiency. However, the risk of infection associated with exposed K-wires remains a significant concern. This study aimed to compare infection rates and clinical outcomes in hand fractures treated with buried versus exposed K-wires. Objective: To assess and compare infection rates, clinical interventions, and patient comfort between buried and exposed K-wires in phalangeal and metacarpal fractures. Method: This study was conducted at Bolan Medical Complex Hospital, Quetta, with 110 patients divided into two groups: Group A (55 patients with buried K-wires) and Group B (55 patients with exposed K-wires). Infection rates were evaluated by categorizing infections as superficial or deep. Clinical outcomes, including the need for antibiotics, K-wire removal, and patient comfort, were assessed for both groups. Results: Group A (buried K-wires) had significantly lower infection rates, with 3.6% of patients developing superficial infections and 1.8% deep infections. In contrast, Group B (exposed K-wires) had higher infection rates, with 10.9% experiencing superficial infections and 5.4% deep infections. Additionally, exposed K-wire patients required more clinical interventions, including increased antibiotic use and K-wire removal. Conclusion: Buried K-wires provide a safer and more comfortable alternative for hand fracture management, with significantly lower infection rates and reduced need for further medical intervention compared to exposed K-wires. Therefore, the use of buried K-wires is preferable for reducing infection risk and enhancing patient comfort.

Prepatellar bursa mucosa: An unreported postoperative complication of patellar fracture.

Patellar fracture is a common injury caused by overstrain of the extensor mechanism or a direct trauma to the knee. The most common complications after patellar fracture are nonunion, infection, post-traumatic arthritis, joint fibrosis, symptomatic hardware, and extensor mechanism failure. These are attributed to the post-fracture flexion and extension movements, the primary damage to the articular cartilage, and the thin soft tissue coverage over the knee. To our knowledge, prepatellar bursa mucosa is an unreported postoperative complication of patellar fracture. We describe a case of a 58-year-old woman with a left patellar fracture from a fall. Complete healing was achieved after in 2 months postoperatively using the improved Kirschner wire tension band and a cable grip system; however, at 7 months postoperatively, a prepatellar skin mass appeared. The patient reported prepatellar discomfort with no pain and influence of movement of the knee and daily life. One year postoperatively, we surgically removed the implants and mass. The pathological result showed bursa mucosa. The literature review shows that pain, secondary knee dysfunction, fracture nonunion, and malunion are postoperative complications of patellar fractures. However, prepatellar bursa mucosa have not been previously reported as a postoperative complication. This case highlights the need for appropriate placement of the intraoperative implant in adults with patellar fractures.

Kirschner wire intramedullary fixation combined with improved nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures

Background and objectiveNice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures.MethodsA retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017–December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner’s wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients’ self-perception, subjective satisfaction and shoulder joint function were compared.ResultsThe operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment.ConclusionThe use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results.