Kirschner Wire Research Articles

Management of extremity and pelvic fractures in earthquake: our observations and recommendations

BackgroundEarthquakes frequently cause injuries to the musculoskeletal system. Studies conducted after earthquakes often report on injured limbs, fractures, and surgeries. This study aimed to enhance preparedness for future earthquakes by acquiring knowledge about the prevalence of fractures and the relationship between fracture types and injury mechanisms.MethodsA retrospective analysis was conducted on medical records of patients with fractures admitted to our hospital following the 2023 Kahramanmaraş Earthquake. Patients with fractures resulting from traffic accidents or other causes unrelated to earthquakes were excluded. The recorded data included age, gender, fracture site, fracture type, mechanism of injury, date, duration of surgery, and peak creatine kinase (CK) level. The injury mechanisms were classified into four main categories: injured by falling objects, falling while running, falling from height, and being trapped under rubble. The study investigated the relationship between fractures and other factors.ResultsThe study included 185 patients with a mean age of 39.62 ± 20.83 years. The most frequent mechanism of injury was being trapped under rubble. In total, there were 214 fractures, with pelvic fractures being the most common (21.50% of all fractures). Tibia fractures were the most common fractures in the lower extremities (15.89%). Women had a significantly higher occurrence of pelvic fractures (33.3%) compared to men (14.5%) (p = 0.003). The frequency of pelvic fractures significantly increased as age decreased (p = 0.007). Patients with pelvic fractures had a significantly greater peak CK concentration (p = 0.006). Open fractures were more common in the first few days, and Kirschner wires were the first treatment applied at a mean of 74 h and external fixators at a mean of 94.3 h.ConclusionInjuries from falling objects from roofs and jumping from heights are important in earthquakes. In addition to lower extremity fractures, pelvic fractures are common in earthquake disasters. Most pelvic fractures are simple lateral compression fractures and it is important to follow the patients for crush syndrome in the first days instead of focusing on definitive fracture treatment. Open fractures should be prioritized for fracture surgery within the first few days. External fixators and Kirschner wires are recommended. Closed fractures should be treated conservatively and definitive surgical procedures should be postponed to the following weeks.

Innovative modifications in the K-wires: A boon for resource-constrained orthopedic hospitals

Objectives: Kirschner wires (K-wires) in orthopedic surgery have stood the test of time. They have several advantages and very few disadvantages. Being the most used and easily available implant, K-wires are very important in this specialty. Certain hand and wrist surgeries require specialized implants, which can be costly and not readily available in smaller hospitals and lesser developed nations. The authors want to discuss improvisation in the K-wire design in the form of (1) the introduction of crimping in the K-wire to cut them in flush with the cortex to avoid the infection associated with the unburied K-wire left outside the skin. (2) Incorporation of a hole in the above-mentioned crimped wire to make a modified suture anchor. (3) The threads at the tip and the shaft of the wire will make it useful in maintaining the released thumb web. Methods: Our study included 11 cases of crimped K-wires, eight cases with a hole (like a suture anchor), and five cases of threaded K-wires. Patients were followed up with radiographs, and a functional assessment was performed using mini disabilities of the arm, shoulder, and hand scoring. Results: All patients had good radiological and functional outcomes with no implant-related complications reported. Conclusion: K-wire modifications can be a game changer in small centers in developing countries. Our described modifications can be easily replicated, improving patient care by significantly reducing the cost of the treatment without compromising the final outcome.

Buried or exposed kirschner wires in paediatric upper extremity fracture fixation: A systematic review and meta-analysis of infection rates and complications.

Paediatric upper limb fractures are commonly treated with Kirschner (K) wire fixation, which can be buried or left exposed. Although both techniques are widely used, controversy remains regarding infection risk, complications, and other clinical outcomes between buried and exposed K-wires. This systematic review and meta-analysis aimed to compare infection rates and secondary outcomes between buried and exposed K-wires in paediatric upper limb fractures located distal to and including the elbow, and proximal to the carpus. A systematic review of the literature was conducted according to PRISMA guidelines, with searches performed across Medline, EMBASE, and the Cochrane Library up to July 2023. Studies were included if they directly compared buried and exposed K-wires in paediatric patients (under 18 years old) and reported on infection rates. Meta-analysis was conducted to compare overall infection rates. Pooled means were used to compare secondary outcomes. Bias was assessed using the ROBINS-I and RoB2 tools. Fifteen studies involving 1,854 participants were included. The meta-analysis showed that buried K-wires were associated with a significantly lower risk of overall postoperative infection compared to exposed K-wires (RR 0.33; 95 % CI 0.22 to 0.50; p< 0.001). The risk of deep infection requiring further surgery was 1.74 % in buried K-wires (95 % CI: 0.72 % to 2.75 %) and 2.07 % in exposed K-wires (95 % CI: 0.55 % to 3.59 %). Skin erosion was a common complication of buried K-wires, with a pooled mean rate of 13.0 %. Buried K-wires were associated with a higher likelihood of requiring removal in theatre (84.4 % vs. 4.2 %). Time to K-wire removal was longer in the buried group (10.9 weeks vs. 5.3 weeks). Re-operation and bone union failure rates were similar between groups. Our systematic review and meta-analysis suggest that, while buried K-wires are associated with lower overall infection rates, the risk of deep infection is comparable between buried and exposed K-wires. Buried K-wires show higher rates of skin erosion and increased need for removal in theatre. Given these findings, exposed K-wires offer a safe and more cost-effective option for paediatric upper limb fracture fixation. Further studies are needed to assess patient-reported outcomes and environmental impacts.

Double Fluoroscopy Techniques for Closed Reduction and Percutaneous Pinning in Pediatric Supracondylar Humeral Fractures: Fluoroscope Positioning and a Case Series

Objective: Percutaneous pinning for supracondylar humeral fractures (SHFs) requires precise pin insertion while maintaining reduction making fluoroscopy indispensable for this procedure. However, it is currently difficult to obtain good-quality two-directional images with one fluoroscopy. This study aimed to report the outcomes of a closed reduction and internal fixation technique using 2 fluoroscopes simultaneously for pediatric SHF. Patients and Methods: Thirty-eight children were identified as having SHF (aged &lt;16 y) who underwent closed reduction and percutaneous pinning. Regarding fracture type (Gartland classification), 10 patients had type II fractures, and 28 patients had type III fractures. The first fluoroscope used for the anteroposterior view was positioned from the patient’s cephalad side. The second fluoroscope used for the lateral view was positioned from the patient’s caudal side. By arranging 2 fluoroscopes from the craniocaudal side, it was possible to secure sufficient standing space for operators who maintained the reduction and inserted the pins. Results: Although this method was intricate and time-consuming for preoperative positioning during fluoroscopy, it was possible to monitor accurate images in 2 directions simultaneously during surgery. Consequently, we were able to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction. There were no complications. Conclusion: Procedures using 2 fluoroscopes simultaneously make it possible to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction.

Dorsally displaced distal radial double-column Die-punch fractures by dorsal approach external fixator combined with Kirschner wires

Investigating the clinical efficacy of treating dorsally displaced distal radial double-column Die-punch fractures using a dorsal approach external fixator combined with Kirschner wires. Retrospectively analyzed the clinical data of 15 patients with distal radial double-column Die-punch fractures treated with an external fixator combined with Kirschner wire between July 2020 and January 2023. There were 10 males and 5 females;6 cases on the left side and 9 on the right;age ranged from 22 to 76 years old. Recorded the preoperative and the final follow-up Cooney wrist function scores for the patients. The fracture healing time, and occurrence of complications were recorded. All 15 patients were followed up ranged from 12 to 16 months post-operation. All fractures achieved bony union, healing time ranging form 8 to 16 weeks. Not a single patient exhibited complications such as surgical site infection, fracture redislocation, or tendon injury. All individuals had their Kirschner wires and external fixation devices removed six weeks post-operatively and commenced rehabilitative therapy for wrist articulation. The Cooney wrist function scores at preoperative and ranged from 5 to 45 scores, at the latest follow-up ranged from 65 to 100 scores. At the final follow-up, the results were assessed as excellent in 10 patients, good in 4 patients, and fair in 1 patient. The clinical efficacy of treating distal radial double-column Die-punch fractures using a dorsal approach external fixator combined with Kirschner wires is satisfactory.

Clinical efficacy of open reduction and internal fixation with plates versus minimally invasive Kirschner wire fixation for osteoporotic Colles' fractures

To compare the short-term clinical efficacy and safety of closed reduction with Kirschner wire fixation versus open reduction with plate fixation for treating osteoporotic Colles' fractures in middle-aged and elderly patients. Between January 2018 and January 2023, 119 patients with Colles fractures were retrospectively analyzed, including 39 males and 80 females, aged from 48 to 74 years old with an average of(60.58±6.71) years old. The time from injury to operation ranged 1 to 13 days with an average of (5.29±2.52) days. According to the surgical method, they were divided into Kirschner wire fixation group (Kirschner wire group) and plate internal fixation group (plate group). In Kirschner wire group, there were a total of 68 patients, comprising 21 males and 47 females. The average age was (61.15±6.24) years old, ranged from 49 to 74 years old. Among them, 41 cases involved the left side while 27 cases involved the right side. In the plate group, there were a total of 51 patients, including 18 males and 33 females. The average age was (59.78±5.71) years old ranged from 48 to 72 years old. Among them, there were 31 cases on the left side and 20 cases on the right side. The following parameters were recorded before and after the operation:operation time, intraoperative blood loss, hospitalization days, hospitalization expenses, postoperative complications, and radiographic parameters of distal radius (distal radius height, ulnar deviation angle, palmar tilt angle). The clinical efficacy was evaluated at 3 and 12 months after the operation using Gartland-Werley and disabilites of the arm shoulder and hand (DASH) scores. The patients in both groups were followed up for a duration from 12 to 19 months with an average of(13.32±2.02) months. The Kirschner wire group exhibited significantly shorter operation time compared to the plate group 27.91(13.00, 42.00) min vs 67.52(29.72, 105.32) min, Z=-8.74, P=0.00. Intraoperative blood loss was also significantly lower in the Kirschner wire group than in the plate group 3.24(1.08, 5.40) ml vs 21.91(17.38, 26.44) ml, Z=-9.31, P=0.00. Furthermore, patients in the Kirschner wire group had a shorter length of hospital stay compared to those in the plate group (8.38±2.63) days vs (11.40±2.78) days, t=-3.12, P=0.00. Additionally, hospitalization cost was significantly lower in the Kirschner wire group than in the plate group 10 111.29(6 738.98, 13 483.60) yuan vs 15 871.11(11 690.40, 20 051.82) yuan, Z=-5.62, P=0.00. The incidence of complications was 2 cases in the Kirschner wire group and 1 case in the plate group, with no statistically significant difference(P>0.05). At 3 months postoprative, the radial height of the Kirschner wire group was found to be significantly smaller than that of the plate group, with measurements of (11.45±1.69) mm and (12.11±1.78) mm respectively (t=-2.06, P=0.04). However, there were no statistically significant differences observed in ulnar deviation angle and palmar tilt angle between the two groups (P>0.05). The DASH score and Gartland-Werley score in the Kirschner group were significantly higher than those in the plate group at 3 months post-operation (19.10±9.89) vs (13.47±3.51), t=4.34, P=0.00;(11.15±3.61) vs (6.41±2.75), t=8.13, P=0.00). However, there was no significant difference between the two groups at 12 months post-operation (P>0.05). Compared to plate internal fixation, closed reduction with Kirschner wire support fixation yields a slightly inferior recovery of radial height;however, there is no significant disparity in the functional score of the affected limb at 12 months post-operation. Nonetheless, this technique offers advantages such as shorter operation time, reduced intraoperative blood loss, decreased hospitalization duration, and lower cost.

Zero-incision treatment of supracondylar humeral fractures in extremely unstable Gartland type Ⅳ children by percutaneous prying combined with modified rotary reduction with Kirschner wire

To investigate the clinical efficacy of percutaneous prying combined with modified rotary reduction with needle in the treatment of supracondylar fracture of humerus in Gartland type Ⅳ children, and to evaluate the postoperative elbow joint function, the incidence of elbow varus deformity and the application prospect of this technique. A total of 98 children diagnosed with Gartland type Ⅳ supracondylar humeral fractures between June 2020 and January 2023 were included in this study, comprising of 57 males and 41 females. The age ranged from 2 to 14 years old with an average of (6.24±4.76) years old. There were 48 cases on the left side and 50 on the right side. The time interval from injury to surgery ranged from 2 hours to 2 days, and emergency operation was performed in 26 cases. During the operation, the Kirschner wire was inserted bluntly into the broken end of the fracture using the lever principle, and the reduction was performed by percutaneous prying. Then the modified rotary reduction method with kirschner wire was used to close and reset the Kirschner wire internal fixation, and zero incision was achieved in all cases. Flynn score was used to evaluatal the function and appearance of the elbow joint at 6 months after operation. The operation was successfully completed by all 98 children, and they were followed up for a duration from 6 to14 months with an average of (9.82±3.51) months. The fractures in all cases healed, the time ranged from 6 to 8 weeks with an average of (6.72±1.17) weeks. The Flynn function score of the elbow joint was rated as excellent in 95 cases and good in 3 cases at the 6-month postoperative evaluation. No related complications occurred, such as cubitus varus deformity, osteofascial compartment syndrome, Kirschner wire rupture or rejection, iatrogenic vascular and nerve injury, Volkmann's contracture or ossification myositis. Percutaneous pry extraction combined with modified rotary reduction with needle in the treatment of humeral supracondylar fracture in extremely instability Gartland type Ⅳ children has the advantages of zero incision, little trauma, safety and good efficacy, and minimization of surgical trauma and scar formation. The postoperative elbow joint function recovery is good.

Short-term clinical efficacy of unilateral external fixator combined with percutaneous Kirschner wire fixation in the treatment of type C1 distal radius fractures in elderly patients

To investigate the short-term clinical effect of closed reduction single arm external fixator combined with percutaneous needle fixation in the treatment of C1 distal radius fracture in elderly patients. Between December 2022 and December 2023, a total of 60 elderly patients diagnosed with type C1 distal radius fractures were treated, comprising 9 males and 51 females. The age ranged from 65 to 84 years old, with an average of (72.69±8.14) years old. Among them, there were 18 cases on the left side and 42 cases on the right side. There were 55 cases of falling injury and 5 cases of traffic accident injury. According to the different surgical methods, the patients were divided into observation group and control group, with 30 cases in each group. The control group underwent manual reduction and unilateral external fixator fixation, consisting of 4 males and 26 females. The mean age was (72.54±8.67) years old. The body mass index (BMI) was (20.61±2.17) kg·m-2. There were 10 cases on the left side and 20 cases on the right side. Among them, there were 27 cases of falling injury and 3 cases of traffic accident injury. The observation group was treated with manual reduction and unilateral external fixator combined with percutaneous Kirschner wire fixation, including 5 males and 25 females. The mean age was (72.76±7.23) years old. BMI (20.82±2.03) kg·m-2. The left side was involved in 8 cases and the right side in 22 cases. There were 28 cases of falling injury and 2 cases of traffic accident injury. The changes in radial height, ulnar declination, palmar inclination angle parameters and patient-rated wrist evaluation (PRWE) were assessed on X-ray films before surgery, 2 days after surgery, and 12 weeks after surgery between the two groups. All surgical procedures were successfully completed in both groups without any significant complications. All patients were followed up for a duration from 12 to 20 weeks with an average of(14.50±2.78) weeks. The two groups exhibited significant differences in radial height, palmar inclination angle, and ulnar deviation angle at 2 days and 12 weeks post-operation (P<0.05). However, there was no statistically significant difference observed in radial height, palmar inclination, and ulnar deviation between the two groups at 2 days after the operation (P>0.05). There were significant differences in radial height, palmar inclination angle, and ulnar deviation between the two groups at 12 weeks after operation (P<0.05). At 2 days and 12 weeks after the operation, there were significant differences in PRWE scores of the two groups compared with preoperative scores(P<0.05). At 2 days after the operation, there was no significant difference in PRWE score between the two groups (P>0.05). The PRWE score showed a significant difference between the two groups at 12 weeks post-operation(P<0.05). The combination of closed reduction and unilateral external fixator, along with percutaneous pin fixation provides move stable fixation for type C1 distal radius fractures. Gradual removal of external fixator further facilitatse the recovery of wrist joint function.

Tibial Plateau Angle Changes following Repair of Salter-Harris Type 1 and 2 Fractures in Dogs.

To determine (1) whether the tibial plateau angle (TPA) in dogs with Salter-Harris type 1 (SH-1) or type 2 (SH-2) fractures of the proximal tibial physis significantly decreases in the time between diagnosis and reevaluation following surgical repair and (2) whether the method of surgical repair influences the change in TPA over time. This study was a retrospective study. Medical records from 2017 to 2022 were reviewed to identify dogs with SH-1 or SH-2 fractures of the proximal tibial physis that had undergone surgical repair with Kirschner wires (K-wires), with or without a tibial tuberosity tension band. The TPA of the affected limb was measured by four investigators on radiographs taken prior to surgery, immediately postoperatively and at 4-8 weeks follow-up, with the average values recorded. A total of 32 dogs, 22 fractures repaired with K-wires and a tension band, and 10 with K-wires only. There was a mean decrease in TPA from injury to first reevaluation of 5.89 degrees (p < 0.001) and from immediately postoperatively to first reevaluation of 2.2 degrees (p = 0.018); however, no significant decrease in TPA was observed when comparing fractures repaired with or without a tension band. The TPA of dogs with SH-1 and SH-2 fractures of the proximal tibial physis decreased in the reevaluation interim following repair with K-wires with or without a tension band. Despite initial imperfect reduction, the risk of cranial cruciate ligament rupture may not be increased, potentially reducing the need for additional surgery if high TPA is observed postoperatively. This study was overrepresented by small breeds, and future studies on large and giant breeds with extended follow-up would be indicated.

A comparative study on the efficacy of kirschner wire tension band combined with anchor cross-suture internal fixation versus partial patellectomy in the treatment of comminuted inferior pole patellar fractures

ObjectiveThe treatment of comminuted inferior pole patellar fractures has long posed a challenge for orthopedic surgeons. This study aims to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band combined with anchor cross-suture fixation versus traditional partial patellectomy in the treatment of comminuted inferior pole patellar fractures.MethodsA retrospective analysis was conducted on 14 patients who underwent Kirschner wire tension band combined with anchor cross-suture fixation (Group A) in our department of orthopedics from September 2020 to April 2022. Additionally, we matched 14 patients with similar baseline characteristics who received inferior pole patellectomy combined with patellar tendon repair (Group B). The two groups were compared in terms of operative time, intraoperative blood loss, postoperative complications, and at the final follow-up, knee range of motion (ROM), visual analogue scale (VAS) score, Bostman knee function score, peak knee torque, and Insall-Salvati (IS) ratio.ResultsAll patients were followed up for more than 12 months. At the final follow-up, Group A showed significantly better outcomes than Group B in terms of knee range of motion (ROM), Bostman knee function score, knee VAS score, and average peak knee torque, with statistically significant differences (P < 0.05), indicating faster postoperative recovery and better clinical results in Group A. The IS ratio of the injured knee in Group B was 0.71 ± 0.66, less than 0.8, suggesting a decrease in patellar height. There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, or incision length (P > 0.05). In Group A, one patient experienced complications from hardware irritation, while in Group B, one patient had postoperative knee pain, and two patients experienced knee extension weakness after cast removal and rehabilitation.ConclusionKirschner wire tension band combined with anchor cross-suture fixation for the treatment of inferior pole patellar fractures yields satisfactory results. This technique provides reliable fixation, restores the original extensor mechanism, promotes early postoperative rehabilitation, and reduces the incidence of complications, making it suitable for clinical application and widespread use.Evidence levelLevel III (retrospective comparative study)

Management of Neglected Lateral Humeral Condylar Fracture by Open Reduction and Kirschner Wires in Children during the COVID-19 epidemic

Management of Neglected Lateral Humeral Condylar Fracture by Open Reduction and Kirschner Wires in Children during the COVID-19 epidemic

Early Postoperative Outcomes of Surgical Fixation of Proximal Phalanx Fractures With Intramedullary Nails Versus Kirschner Wires.

Kirschner wire (K-wire) and intramedullary (IM) screw fixation are accepted techniques for treatment of unstable proximal phalanx fractures, but comparative reports are lacking. This study aimed to evaluate early clinical outcomes following treatment with K-wire or IM fixation. A retrospective review of all proximal phalanx fractures treated surgically at a single center by multiple surgeons was performed from May 1, 2019 to March 1, 2024. Inclusion criteria consisted of patients above 18 years of age with transverse or short-oblique proximal phalanx fractures, without associated soft-tissue injury or involvement of multiple digits, who were treated with IM screw or K-wire fixation. Outcomes were available for 49 patients (27 K-wire, 22 IM nail). Chart review was performed to assess range of motion (ROM) and Quick Disabilities of the Arm, Shoulder, and Hand outcomes 6 and 12 weeks postoperatively. A significant difference was found in total active motion (TAM) (207.4° vs 150.8°, P = .03) and proximal interphalangeal (PIP) joint motion (71.8° vs 54.5°, P = .04) between the IM and K-wire cohorts 12 weeks after surgery. Proximal interphalangeal motion was also significantly different (57.6° vs 34.3°, P = .03) 6 weeks after surgery with no significant difference in TAM (176.6° vs 122.1°, P = .13) at that time point. Quick Disabilities of the Arm, Shoulder, and Hand scores 12 weeks after surgery were not significantly different between the IM (M: 15.8) and K-wire (M: 28.15) groups (P = .13). Total active motion and PIP joint motion were found to be significantly higher 12 weeks postoperatively following IM fixation compared to K-wire fixation for extra-articular proximal phalanx fractures.

Application of elbow skin fold extension line in extreme elbow flexion in ulnar Kirschner wire insertion of extended supracondylar humeral fractures in children

To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups ( P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. The closed reduction rate of the study group was significantly higher than that of the control group ( P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] ( χ 2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group ( P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups ( P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group ( P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups ( P>0.05). In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.

Comparison of effectiveness between two surgical methods for humeral lateral condyle fractures in children

To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.

Application of suture-stretching technique in repairing skin defect of lower limb

BackgroundWound repair methods are commonly used in clinical practice, such as skin graft and flap repair, which can cause secondary injuries, and high costs. Many methods for skin stretching and repair have been reported domestically and internationally. However, their clinical use is limited owing to lack of equipment, complexity, and high costs. Therefore, we introduce a novel technique to repair wound.MethodsWe collected 125 patients with skin defects of lower limb from January 2019 to June 2024. Among them, 77 cases were repaired using our novel technique (suture-stretching technique, we designed a simple and feasible skin traction device that used 2–0 (polydioxanone sutures) PDS sutures, 2.0 mm Kirschner wires, and nylon binding tapes to repair skin defects and accommodate irregular wounds according to Ilizarov’s “tension-stress” law, SS group); skin grafting (SG group) was used for repairing 48 cases of wounds. We collected the data of the two groups, including wound size, number of debridements, operation time, wound healing time, hospital stays, and surgury cost, and the data were analyzed statistically.ResultsThere was no statistically significant difference between the two groups in terms of age, gender, wound size and wound healing time (p > 0.05).However, the number of debridements (p < 0.0001), operation time (p < 0.0001), hospital stays (p < 0.0001) and surgery time (p < 0.0001) in the suture group were better than those in the skin grafting group with statistically significant difference.ConclusionThe application of suture-stretching technique to repair skin defect wounds of lower limb have good clinical efficacy, which can reduce the number of operations, shorten the operation time, and avoid secondary injuries caused by skin graft or skin flaps. Meanwhile, it also has obvious advantages regarding hospital stays and surgery costs.

Comparative Outcomes Between Three Different Techniques in the Fixation of Ulnar Styloid Fractures.

This study aims to compare the clinical and radiological outcomes of three different techniques used in the surgical treatment of ulnar styloid fractures. Ulnar styloid fractures treated surgically between 2012 and 2022 were evaluated retrospectively. There were three groups in the study: Group I (Kirschner wire, N= 19), Group II (tension band, N= 27) and Group III (headless compression screw, N= 25). The Gaulke classification was applied to categorise the fractures. After a follow-up period of at least one year, range of motion, Modified Mayo Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), Visual Analogue Scale (VAS) and grip strength were measured. In addition, radiological union, bone resorption and dorsal subluxation of the DRUJ were evaluated. There was no difference between the three groups in terms of demographic data. Gaulke type 2 A was more frequently observed in all three groups (47.4%, 74.1%, 64%, respectively). Range of motion (flexion, extension, supination, pronation) was similar in all three groups (p>0.05). QDASH and MMWS were similar in all three groups. Grip strength was significantly lower in Group I than in Group II (p=0.039). Radiological outcomes (nonunion, dorsal subluxation, bone resorption) were similar in all three groups. Implant irritation was significantly higher in Group II (p=0.026). K-wires, tension band wiring and headless compression screws yield similar clinical and radiological outcomes in the surgical treatment of unstable ulnar styloid fractures. However, the need for secondary surgery is more frequent when a tension band is used. Level IV.

Effectiveness analysis of three internal fixation methods in treatment of avulsion fracture of tibial tubercle in adolescents

To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents. Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate). There was no significant difference in the baseline data of age, gender, side, cause of injury, Ogden classification, and time from injury to operation among the three groups ( P>0.05). The range of motion (ROM), weight-bearing time, normal activity time of knee joint, and the hospital for special surgery (HSS) score at last follow-up were recorded and compared among the three groups. Recorded whether the fracture was displaced, whether the fracture line was blurred at 1 month after operation, whether there was epiphyseal dysplasia, and whether there was incision infection and other complications. There was no significant difference in hospital stay between the groups ( P>0.05). All patients were followed up 10-24 months, with an average of 14.3 months; there was no significant difference between the groups ( P>0.05). All the incisions healed well without soft tissue irritation or fracture nonunion, and no limb shortening deformity or epiphyseal dysplasia was found during follow-up. At 1 month after operation, the knee joint ROM and hospitalization expenses in group A were better than those in groups B and C, the fracture healing time, knee joint weight-bearing time, and normal activity time of knee joint were better than those in group C, and the hospitalization expenses in group C were better than those in group B, with significant differences ( P<0.05); there was no significant difference in the other indicators between the groups ( P>0.05). In group A, the fracture line was blurred 1 month postoperatively, the fracture ends were in close contact, and there was no fracture displacement; in groups B and C, the fracture line was clear in 2 cases, and 1 case in group C had slight fracture displacement; except for 1 case in group B, there was no fracture split in the other two groups. There was no significant difference in the incidences of blur of fracture line, fracture displacement, and intraoperative bone split between the groups at 1 month after operation ( P>0.05). At last follow-up, the HSS scores of knee joints in the three groups were excellent and good, and there was no significant difference between the groups ( P>0.05). Hollow screw combined with Kirschner wire tension band technique is effective in treating adolescent AFTT, which has the advantages of stabilizing fracture, accelerating fracture healing and rehabilitation, early feasible knee joint functional exercise, and reducing hospitalization expenses.

Outcomes of Patients with Tendinous Mallet Finger Injury Managed with DIPJ Extension Splinting vs Axial Pinning

Background: Mallet finger, a common finger injury, results from damage to the distal extensor tendon, causing a flexion deformity at the distal interphalangeal joint. While conservative treatment with splinting is often effective, surgical intervention using Kirschner wire fixation may be necessary for complex cases or non-compliant patients. Objective: This study compared the outcomes of two treatments for tendinous mallet finger: splinting and pinning. Researchers analyzed patient demographics, distal interphalangeal joint range of motion, clinical outcomes, and complication rates between the two groups. Methodology: We retrospectively reviewed patients diagnosed with tendinous mallet finger injury managed conservatively or surgically from 2018 to 2022 in a tertiary hospital. Result: Both surgical and conservative treatments were effective, as shown by the excellent total active motion scores and satisfactory qDASH (Disabilities of the Arm, Shoulder, and Hand) outcomes in both groups. However, when comparing the Miller and Crawford criteria, the surgical group consistently showed slightly better functional outcomes. Conclusion: Both treatments yielded similar results for range of motion, extension lag, and flexion loss, making them equally effective. However, axial pinning may result in better subjective improvement and satisfaction.

Successful arm replantation using traditional surgical techniques: a case report from a low-resource country

Introduction: Upper limb replantation requires rapid intervention by a multidisciplinary team and appropriate equipment to rescue the limb. Note that the success of the operation and the decision to perform it depend on several factors. This case report presents an upper limb replantation performed using traditional surgical techniques. Case presentation: A 12-year-old boy presented to our hospital with a crushing injury to the right upper arm, which was amputated at the lower third of the humerus, with the biceps brachii tendon remaining intact. The first aid included resuscitation and intravenous fluid administration to maintain hemodynamic stability. The surgeons replanted the arm by immobilizing the fracture with Kirschner wires, performing several arterial and venous anastomoses, and suturing the damaged nerve and muscle aponeurosis in a 3-h operation. The patient was discharged after 5 days without any complications but was recommended to undergo physical therapy to regain his arm movement and is currently undergoing monthly follow-ups to ensure the required improvement. Discussion: Upper limb replantation is a complicated process that enables the conservation of arm function and appearance. This requires rapid intervention by a multidisciplinary team. Additionally, advanced equipment, such as microsurgical tools, provides greater success and ease of revascularization. Conclusion: To successfully re-implant an amputated limb, several factors must be considered: surgeon experience, availability of necessary equipment, and provision of post-operative care. Despite lacking advanced tools, surgeons can rely on their surgical skills to overcome this challenge.

Treatment of scaphoid waist nonunion with iliac crest bone graft and double Kirschner wire fixation: An observational clinical study

Treatment of scaphoid waist nonunion with iliac crest bone graft and double Kirschner wire fixation: An observational clinical study