Kirschner Wire Osteosynthesis Research Articles

Analysis of the treatment of comminuted fractures of tubular bones of the extremities in cats and dogs

Surgical resolution of comminuted fractures of tubular bones is an urgent issue for practicing veterinarians. Comminuted fractures account for 52%, transverse fractures for 8.7%, oblique fractures for 26.1%, and compression fractures for 13.0% of total canine fractures. Thus, comminuted fractures of the tubular bones of the extremities are the most frequent. There are several types of bone fixation in comminuted fractures. Many authors do not recommend using of intramedullary osteosynthesis in the treatment of this type of fracture since it is not possible to connect all bone fractures. The aim of this study was to compare the methods of surgical treatment of comminuted fractures in dogs and cats admitted to the clinics and to choose the most optimal ways of treatment. In total, 4,396 cats and dogs were admitted to the clinic, excluding those admitted for vaccination. The surgical department received 35% of the total number of animals. Patients with bone and joint pathology accounted for 19% of all surgical causes and to 7% of all animals admitted to the clinic. In the group of 9 cats and 9 dogs three main types of fracture were diagnosed: transverse fracture in 6 animals (4 dogs and 2 cats), oblique fracture in 4 animals (3 dogs and 1 cat) and comminuted fracture in 8 animals (2 dogs and 6 cats). The article is illustrated with X-rays images of the clinical cases presented. In order to perform osteosynthesis using a single-plane bilateral external fixator, the authors injected 2-3 Kirchner spokes each into the proximal and distal bone fragments by drilling through the bone while perforating soft tissue on both sides. The ends of the spokes on both sides were bent towards the opposite fragment, parallel to the bone axis, at a distance of 1.0 to 3.0 cm from the skin surface. The ends of the spokes form the rods of a bilateral single-plane fixator. The rod-forming spokes are tightened with wire serrations on 3-4 levels and additionally fixed with fast hardening plastic (turbocast) or bone cement (Palacos, GMW, Osteobond) while controlling the fracture reposition. Combination with wire serclages, sutures, compression screw or intramedullary Kirschner wire osteosynthesis is possible.

Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?

The treatment of the displaced fracture of the lateral condyle of the distal humerus in children aims not only to avoid nonunion, malalignment, and impairment of the range of motion of the elbow but also to prevent delayed healing and the development of any prearthrotic deformity. To date there is no agreement on what kind of osteosynthesis should be used. So far, the screw fixation and Kirschner wire fixation have both been applied. Therefore, the goal of this study was to compare the outcome of these two methods. A retrospective cohort study was undertaken including 43 patients aged 2 to 13 years who underwent osteosynthesis for a condylar fracture of the humerus over a period of 10 years. The electronic archive, including the radiological diagnostics, was analyzed. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an α level of p = 0.05. Kirschner wire fixation was performed in 48.9% of condylar fractures of the humerus while screw fixation (alone or in combination with a pin) was assessed with a percentage of 51.1% of the cases in this study. Screw fixation only was applied in 20.9% of fractures of the lateral condyle. The selection of the method was independent of the age of the patient (p = 0.2). The comparison of the rate of complications and an impaired range of motion after Kirschner wire osteosynthesis to the rate after screw osteosynthesis showed a significantly lower percentage for the Kirschner wire group (p = 0.046). No case of nonunion, nerve palsy, or pin migration was detected in any patient in this study. Kirschner wire fixation of condylar humeral fractures in children resulted in a lower rate of complications than screw fixation. No case of nonunion of the fracture was found in the patients that we investigated so that we conclude that Kirschner wires sufficiently adapt the fracture in these cases. Level III.

Effect of buried vs. exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures: A systematic review and meta-analysis

BackgroundDuring Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures, a key clinical decision is whether to leave a Kirschner wire exposed or bury it beneath the skin. Therefore, we conducted a meta-analysis to evaluate the clinical effect of buried and exposed Kirschner wire osteosynthesis on phalangeal, metacarpal and distal radial fractures.MethodsPubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched and clinical trials that evaluated buried and exposed Kirschner wire osteosynthesis for phalangeal, metacarpal and distal radial fractures were identified. Methodological qualities of studies were assessed by using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Publication bias was detected using Begg’s test and Egger’s test. Sensitivity analyses were performed by excluding one study at a time to determine whether overall results were reliable.ResultsTwo randomized controlled trials (RCT) and five case-controlled studies involving 1446 patients were included in the analysis. Sensitivity analyses indicated that the results of each study were statistically robust. Begg’s test or Egger’s test revealed no significant publication bias. Our meta-analysis indicated that exposed Kirschner wire osteosynthesis had a significantly higher infection rate than its buried counterpart. Additionally, buried Kirschner wire osteosynthesis resulted in a significantly higher rate of Kirschner wire removal in operating room than the exposed one. Our meta-analysis exhibited no statistical differences between the two procedures in the rate of early pin removal.ConclusionsMeta-analysis of available RCTs and case-controlled studies demonstrated that buried Kirschner wire osteosynthesis had a lower infection rate but tended to lead to more frequent Kirschner wire removal in the operating room as compared to its exposed counterpart.Trial registrationPROSPERO (CRD42018105249).

Functional outcome of closed reduction and k-wiring with modified Kapandji technique for distal radial fractures

Kirschner wire osteosynthesis is a widely accepted method for reduction of distal radial fractures. The present study aims to assess the Functional outcome of Closed Reduction and K-Wiring with the Modified Kapandji Technique for Distal Radial Fractures.

What to do in cases of postoperative damage of the ulnar nerve after K‑wire osteosynthesis of supracondylar humeral fractures in childhood?

Iatrogenic damage to the ulnar nerve after crossed Kirschner wire osteosynthesis of supracondylar humeral fractures is apreventable complication in pediatric traumatology, which occurs in up to 10% of cases. There are strategies in the literature for avoiding this complication but no consistent suggestions for action in the presence of the damage. Within the framework of aquestionnaire survey with the support of the German Society for Trauma Surgery, 198 pediatric and trauma surgeons presented their treatment algorithm based on case examples. In preoperatively known accident-related sensorimotor failure, 76.3% perform revision surgery of the nerve as part of primary care. If the treatment-related nerve damage occurs immediately postoperatively, up to 84.3% do this immediately. The rate depends on the extent of nerve damage (sensory vs. sensorimotor) and the reduction method (open vs. closed). The later the nerve damage is diagnosed, the sooner the original course of treatment with timely metal removal is retained or neurophysiological examinations are included. Respondents used the clinical extent of the lesion, the timing of the diagnosis and the nature of primary care as criteria for the indications in postoperative ulnar nerve damage. Differences in outcome between invasive and waiting strategies cannot be derived from the study.

Functional evaluation of management modalities of three and four part proximal humeral fractures

Introduction: Three and four –part fractures represent 13%-16% of proximal humeral fractures. They occur more frequently in older patients after the cancellous bone has become weakened by senility and osteopenia. Treatment options for these displaced fractures include closed reduction and k-wire fixation, open reduction and internal fixation and arthroplasty. The purpose of the present study was to evaluate the functional results in patient with three and four-part proximal humeral fractures treated by different modalities, over a period of 2 years. Materials and Methods: We present a retrospective study of 40 three-part and four part proximal humeral fractures according to Neer’s classification, treated by simple technique of Kirschner wire Osteosynthesis, open reduction and internal fixation with clover-leaf plate or proximal humeral locking plate system (PHILOS) and hemiarthroplasty of the proximal humerus. The criteria for inclusion were a diagnosis of undisplaced three-part fracture, displaced three and four part fractures confirmed by three independent observers. Results: The study was conducted over a period of two years with an average follow up of 20.7 months (Range: 12 to 40 months). There were 14 undisplaced three-part fractures impacted in valgus, seven displaced three part fractures, two three-part fracture with dislocated head, four four-part fractures with dislocated head. Conclusion: Three-and four-part proximal humeral fractures are difficult injuries to evaluate and treat. Nevertheless, an algorithm for treatment has been devised. Preoperative and intraoperative evaluation must address fracture pattern, bone quality, patient motivation, and expectations. A thorough knowledge of normal glenohumeral relationships is essential to achieve optimal surgical results.

Therapieprinzipien distaler Unterarmfrakturen im Kindesalter

Fractures of the forearm in children represent one of the most frequent injuries. Most are monotraumatic occurring during sport or leisure activities. Diagnosis can be made by conventional X-ray examination in 2 planes. Distal forearm fractures are classified into epiphyseolysis and epiphyseal fractures, metaphyseal greenstick and buckle fractures, complete distal radius and forearm fractures as well as Galeazzi lesions. The vast majority of cases without relevant dislocation can be treated with immobilization employing a cast. The remaining fractures have to be repositioned and restored depending on age and degree of dislocation.The state of the art in surgical therapy is the Kirschner wire osteosynthesis after closed reduction. Especially meta-diaphyseal fractures can alternatively be stabilized with plate osteosynthesis or external fixation. Following these therapeutic principles, prognosis is excellent and most of the injuries heal without any functional impairment.

Primäre Alloarthroplastik des frakturierten Ellenbogens beim hochbetagten Patienten

Inadequate treatment of distal intra-articular fractures of the humerus results in painful restriction of movement or malarticulation. Especially in geriatric patients with osteoporosis, stable osteosynthesis can be difficult. Primary total endoprosthetic replacement of the cubital joint could offer an alternative. In 12 patients with a distal intra-articular fracture of the humerus a cemented semi-constrained Coonrad-Morrey prosthesis was implanted. Patient were followed-up after an average of 13 months and assessed according to the Mayo score. In 6 patients additional computerized tomography was carried out. Minimally invasive Kirschner wire osteosynthesis resulted in immediate postoperative loss of correction due to osteoporosis. As with the external distraction-compression apparatus the ulnar pinholes can form a predetermined breaking point and fixation in a long-arm cast is recommended. The mean Mayo score was 90.5 points and mean range of motion in extension/flexion was 84.5 degrees. In elderly patients primary endoprosthetic treatment of a distal intra-articular fracture of the humerus with a semi-constrained cemented prosthesis may offer an alternative to osteosynthesis thus enabling creation of a mobile, painless and stable cubital joint.

TWO PROCEDURES FOR KIRSCHNER WIRE OSTEOSYNTHESIS OF DISTAL RADIAL FRACTURES

The treatment of displaced Colles-type fractures of the distal part of the radius remains a challenge. Two procedures for closed reduction and Kirschner wire osteosynthesis of these fractures were compared in a prospective randomized study. One hundred consecutive patients with a Colles fracture of the distal part of the radius (AO classification 23-A2, 23-A3, or 23-C1) were treated over an eighteen-month period. One group was managed with the conventional method, described by Willenegger and Guggenbuhl in 1959, in which two Kirschner wires are introduced into the styloid process of the radius. The other group was treated with the Kapandji method, as modified by Fritz et al., in which two Kirschner wires are inserted into the fracture gap and a third is placed through the styloid process. Postoperative care was standardized for both groups and carried out according to a strict procedure. Forty patients who had been operated on according to the modified Kapandji method and forty-one treated with the Willenegger technique were available for follow-up, for a follow-up rate of 81%. The follow-up assessment was performed with a modified version of the Martini score. The median time to follow-up was ten months (range, six to twenty months). The results as assessed with the Martini score were, on the average, good to very good for the patients treated with the Kapandji method and satisfactory to good for the patients treated with the conventional Kirschner wire fixation. The duration of radiographic exposure was significantly shorter with the Kapandji method than with the Willenegger technique. Conventional Kirschner wire fixation remains a good method of osteosynthesis for the treatment of displaced fractures of the distal part of the radius. We found both the functional and radiographic outcomes of the Kapandji method to be significantly better than those of the Willenegger technique. Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

The benefit of gait analysis in functional diagnostics in the rehabilitation of patients after operative treatment of calcaneal fractures

The purpose of our examinations is to determine whether mechanized functional diagnostics can provide evidence of functional deficits in patients after operative treatment of calcaneal fractures, and whether measurable parameters for rehabilitation result. This retrospective study reports on 30 patients with fractures of the calcaneus who were treated between May 1993 and November 1996 with closed and ‘semi-open’ repositioning of the fragments and subsequent percutaneous Kirschner wire osteosynthesis according to the ‘AOFAS Ankle-Hindfoot Scale,’ followed by isokinetic and gait analytical postoperative examination. Prior to beginning deficit-oriented therapy, the AOFAS Ankle-Hindfoot Scale showed that after operative treatment of calcaneal fractures, 63.3% of the patients had a good to very good outcome. Gait analysis indicated significant deficits in functional mobility during the swing phase, manifesting as a diminishment of the active heel lift. At the time of the final assessment, the findings from gait analysis demonstrated that these deficits were no longer evident to any significant extent. The AOFAS Ankle-Hindfoot Scale from the final assessment yielded an increase in good and very good results to a total of 80.0%. Mechanized functional diagnostics is suited to both the detection of functional deficits following reconstructive surgery on the musculoskeletal system and to devising individual, patient-oriented rehabilitation plans.

Orthograde Kirschner wire osteosynthesis. Experiences with intramedullary fixation of the distal metacarpal V fracture

Dislocated metacarpal V fractures, fixed by percutaneous Kirschner wires or other implants near the metacarpophalangeal joint, often show impaired movement despite excellent radiologic findings. We therefore chose an alternative method using intramedullary Kirschner wire osteosynthesis according to Foucher. Twenty-five patients were operated on in a 3-year period and movement of the fingers and complications were examined. Six weeks after operation all fractures were consolidated in anatomical reduction. One patient suffering from an early stage of Sudeck's dystrophy was healed, and no other complications appeared. Three months after treatment all patients achieved free movement of the fingers with anatomical alignment. We therefore recommend intramedullary Kirschner wire osteosynthesis in distal metacarpal V fractures.

Injuries of Distal Clavicular Physis in Children

We report ten patients (all boys) with distal clavicular physeal injuries. Eighty percent of the injuries occurred on the right side. Nine boys were treated conservatively, but one required operation. Kirschner wire osteosynthesis was performed. Regardless of the type of treatment, all patients healed without functional sequelae. In seven of the nine treated conservatively, however, a deformity of the injured shoulder resulted. I suggest that in cases of great displacement of the central metaphyseal fragment resulting in shortening of the clavicle an open reduction with internal fixation is indicated for cosmetic reasons.

Injuries of Distal Clavicular Physis in Children

We report ten patients (all boys) with distal clavicular physeal injuries. Eighty percent of the injuries occurred on the right side. Nine boys were treated conservatively, but one required operation. Kirschner wire osteosynthesis was performed. Regardless of the type of treatment, all patients healed without functional sequelae. In seven of the nine treated conservatively, however, a deformity of the injured shoulder resulted. I suggest that in cases of great displacement of the central metaphyseal fragment resulting in shortening of the clavicle an open reduction with internal fixation is indicated for cosmetic reasons.