Kirschner Wire Placement Research Articles

Successful removal of an intra-pericardic Kirschner wire via fluoroscopy-guided minimal invasive approach: a case report

BackgroundKirschner wires are widely used in trauma surgery. Their migration into the pericardium is a rare but often fatal phenomenon, requiring urgent management.Case presentationWe describe the case of a 65-year-old patient who underwent Kirschner wire placement to treat a humeral head fracture. Three months after the operation, pleural and pericardial effusions with cardiac tamponade were observed, leading to the diagnosis of wire migration within the pericardium. A minimally invasive approach guided by fluoroscopy allowed emergency wire extraction without needing a median sternotomy. The postoperative clinical course was uncomplicated.ConclusionsThe use of pre- and per-operative multimodal imaging allowed for the safe extraction of an intra-pericardial Kirschner wire through a minimally invasive approach.

Navigating Isolated Post-Traumatic Radial Head Dislocation in Adolescents: A Case Report from Bangladesh Emphasizing Management Strategies

Background: Isolated anterior dislocation of the radial head is a rare orthopedic injury, oftenpresenting with distinct clinical features and requiring specialized management. We report the case of an 18-year-old female who presented to our hospital 5 months post-injury, complaining of restricted left elbow joint movement and pain following a fall from a low chair at home. Clinical examination revealed tenderness and anterior dislocation of the radial head, confirmed by radiographs showing isolated anterior dislocation without associated fractures. Closed reduction attempts failed, leading to an open reduction of radial head in combination with correction of malignant with ulnar osteotomy and reconstruction of annular ligament and radio-ulnar Kirschner wire placement for stabilization. An upper arm cast was applied with the forearm in neutral rotation for six weeks. At the 12-month follow-up, the patient exhibited a satisfactory range of motion within reference values, comprising 0-140 degrees of flexion-extension arc, 70 degrees of pronation, and 85 degrees of supination. This range aligned with standards set by the American Society for Surgery of the Hand. The patient reported no impediments in daily activities and returned to her pre-injury level of sports activity based on the Tegner scale. This case underscores the complexity of managing isolated anterior radial head dislocation, highlighting the significance of prompt diagnosis, appropriate reduction techniques, and meticulous postoperative care to achieve optimal functional outcomes. Central Medical College Journal Vol 7 No 1 January 2023 Page: 57-62

A Modified Technique of Percutaneous Fixation of Displaced Pediatric Lateral Humeral Condyle Elbow Fractures (aka the Martini Technique): A Brief Case Series.

Displaced lateral humeral condyle (LHC) fractures have routinely been treated with open reduction, which has known postoperative complications. Recent reports show that closed reduction and percutaneous pinning (CRPP) is a valid treatment. Five pediatric patients with displaced LHC fractures were included in a retrospective case series. Closed reductions (CRs) were facilitated by Kirschner wire placement into the capitellum through a toothed drill guide. The Kirschner wire and drill guide were used like a joystick to manipulate the fragment and maintain reduction for placement of additional Kirschner wires. Patient records were used to determine the number of patients diagnosed with LHC fractures between 2011 to 2022 among six pediatric orthopaedic surgeons at one institution along with the treatment and associated complications. Satisfactory reduction of displaced LHC fractures was achieved with CRPP in all patients with no complications using the "martini" modification. Of 26 LHC fractures, 16 were treated with CRPP/CRPS and 10 with open reduction and percutaneous pinning/open reduction and internal fixation, with four converted from CR to OR. Complications included one superficial infection in the CR group and four stiff elbows and one nonunion in the OR group option for LHC fractures. CRPP is an effective treatment option with a decreased risk of complications. Our modified reduction technique may help improve the success and results of closed treatment of LHC fractures.

Evaluation of a 3-D printed drill guide to facilitate fluoroscopic-assisted Kirschner wire placement for minimally invasive iliosacral screw placement in dog cadavers.

To evaluate the ease and accuracy of using a 3-D printed (3-DP) drill guide to insert Kirschner wires through the ilium and into the sacral body in preparation for minimally invasive iliosacral screw placement in dog cadavers. 10 dog cadavers weighing 20 to 30 kg (mean ± SD, 24.5 ± 5 kg). Kirschner wires were placed using a limited approach to the lateral ilium. Fluoroscopy was used in freehand and 3-DP drill guide application groups to facilitate the placement of a 1.0-mm Kirschner wire that was over-drilled using a 2.5-mm cannulated drill bit. Kirschner wires were placed using a 3-DP drill guide on 1 hemipelvis and freehand wire placement was done on the contralateral hemipelvis. Postprocedural CTs were obtained, and 2-D and 3-D analyses were performed. The Student t-test and Wilcoxon rank sum test were used to compare groups. A Pearson correlation coefficient was performed to evaluate the in-group correlation. Likert scores that assessed the ease of the procedure were significantly greater (P = .04) and the incision length was significantly shorter (P = .016) in the 3-DP drill guide group compared with the freehand group. The time of the procedure, the number of attempts to obtain accurate Kirschner wire placement, and fluoroscopy images did not differ (P > .05) between application groups. Drill tracks were primarily confined to the sacral body, with minor projected screw thread cortical breeches occurred in 1 cadaver in the freehand group and 2 cadavers in the 3-DP drill guide group. The 3-DP drill guide simplified appropriate iliosacral Kirschner wire placement through a smaller incision compared with freehand drilling and would appear to be an efficient, practical instrument to facilitate accurate fluoroscopic-assisted screw placement when stabilizing sacroiliac luxations in dogs.

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation.

Robot-assisted orthopedic surgery has great application prospects, and the accuracy of the robot is the key to its overall performance. The aim of this study was to develop a new orthopedic surgical robot to assist in spinal surgeries and to compare its feasibility and accuracy with the existing orthopedic robot. A new type of high-precision orthopedic surgical robot (Tuoshou) was developed. A multicenter, randomized controlled trial was carried out to compare the Tuoshou with the TiRobot (TINAVI Medical Technologies Co., Ltd., Beijing) to evaluate the accuracy and safety of their navigation and positioning. A total of 112 patients were randomized, and 108 patients completed the study. The position deviation of the Kirschner wire placement in the Tuoshou group was smaller than that in the TiRobot group (p = 0.014). The Tuoshou group was better than the TiRobot group in terms of the pedicle screw insertion accuracy (p = 0.016) and entry point deviation (p < 0.001). No differences were observed in endpoint deviation (p = 0.170), axial deviation (p = 0.170), sagittal deviation (p = 0.324), and spatial deviation (p = 0.299). There was no difference in security indicators. The new orthopedic surgical robot was highly accurate and optimized for clinical practice, making it suitable for clinical application.

Evaluation of a new spinal surgical robotic system of Kirschner wire placement for lumbar fusion: A multi-centre, randomised controlled clinical study.

To introduce a novel robotic system 'Orthbot' that has been developed and tested as a surgical assistant for auto-placement of the K-wire in lumbar fusion. This is a multi-centre, randomized controlled clinical study that includes 56 patients (robot group, RG: 27, free-hand group, FG: 29). Following the pre-operative planning and intra-operative fluoroscopic images, the 'Orthbot' automatically completed registration and K-wire placement under the supervision of the surgeon. Deviation distance (DD) and deviation angle (DA) were used as the primary parameters to evaluate the accuracy of the robotic system. The average DD was 0.95±0.377mm and 4.35±2.01mm, respectively in the RG and FG (p<0.001). The average DA of the K-wire in the coronal plane and the sagittal plane in X-Ray was respectively 6.80±7.79° and 1.27±2.32° in the RG (p<0.001), and 22.22±16.85° and 4.57±3.86° in the FG (p<0.001), which showed a higher accuracy rate in the robotic-assisted cases compared to the free-hand cases. The novel robotic system could achieve accurate K-wire insertions as indicated by the radiological results.

The Two-Component Implant for Interphalangeal Fusion in Toe Deformities.

Although Kirschner wire implantation is popular for treating toe deformities, complications frequently occur. To prevent pin-tract infection and difficult Kirschner wire extraction, several implants have been developed to improve treatment outcomes. Patients who had undergone an interphalangeal fusion by two-component implant for the treatment of toe deformities were included. Thirty-one toes of 21 patients were evaluated retrospectively. American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were used in clinical evaluation. The mean operation duration per toe was 16.4 min (range, 13-26 min). The average AOFAS forefoot score was 42.76 (range, 23-57) preoperatively and 88.76 (range, 70-95) at 34.4 months (range, 26-46 months) after surgery. Mean follow-up was 14.8 months (range, 12-19 months). Compared with before surgery, the AOFAS score was increased significantly after surgery (P = .03 by t test). Three minor complications were encountered. In one patient an infection was observed. After the implants were removed (first month) she was treated successfully by debridement and antibiotic agents and, finally, Kirschner wire placement. The second patient had a fissure fracture at the proximal phalanx, but routine follow-up did not change. In the third patient, the locking mechanism had become loose (detected on day 1 radiography); it was remounted under fluoroscopy without opening the wound. No patients had a cutout, loss of alignment, recurrence, or persistent swelling. Outcomes of arthrodesis using the two-component implant were found to be safe and reliable, especially for hammer toe and fifth toe deformities.

A Novel 3-dimensional–Printed Hand Model to Simulate Bony Fixation With Kirschner Wires Without Fluoroscopy

PURPOSE: Simulation has become a mainstay in medical training. The field of 3-dimensional (3D) printing offers additional benefits to medical simulation, allowing for the development of affordable, custom anatomic models. Surgical subspecialties, like plastic surgery and orthopedics, can reap significant benefits from this technology. Specifically, developing the art of operative planning and mastering unique procedural skills are essential to the armamentarium of the plastic surgeon. One skill that is particularly difficult to master in early training is the use of Kirschner wires (K-wires) for bony fixation of the hand and wrist. Brichacek et al1 have used 3D printing for this specific training purpose, but their construct of silicone and iron-based bones requires fluoroscopy for evaluation of metacarpal K-wire placement, involving more than minimal risk of radiation exposure to trainees (Brichacek et al1). Herein, the purpose of this project is to develop a 3D-printed hand and wrist model that serves as a training and evaluation tool for K-wire placement that is novel, cost-effective, durable, and does not require fluoroscopy. METHODS: This novel hand model utilizes 3D printing technology and silicone molding. Data obtained from a computed tomography scan of a healthy hand and wrist were used to 3D print a reusable mold for the fabrication of the silicone-based “soft tissue.” Computed tomography scan data were also used to print out the bony structures of the hand and wrist (carpal bones, metacarpals, and phalanges) from ABS Filament on a UPrint SE+ 3D printer (Stratasys; Eden Prairie, Minn.). Three-dimensional–printed bones were placed in the 3D-printed mold and sealed with silicone to recreate the surrounding soft tissue. Thin filaments connecting the bones were broken after the silicone set, allowing for realistic simulation of hand joint mobility. Bony structures were exchanged and replaced after use via a palmar incision. RESULTS: To test durability of the model, 20 K-wire placements were performed. Preliminary trials demonstrated the silicone to be durable, withstanding multiple K-wire passes without breakdown. Additionally, the metacarpal bones were easily replaced for repeat use. Bones were intentionally printed with a linear infill pattern (lattice matrix) to evaluate disruption of the lattices by K-wire passes. Accuracy and proficiency of K-wire placement are assessed by direct visualization of the disrupted matrix compared to conventional assessment with fluoroscopy. Total cost of material for each hand model was $25.00. For reference, the largest bone in the hand (metacarpal) could be replaced for a material cost of $0.50. CONCLUSIONS: Implementation of 3D printing and silicone casting can be used to produce a cost-effective and reproducible training tool for bony fixation of the hand and wrist. We are currently validating our 3D-printed K-wire placement hand and wrist model for educational utility among plastic surgery residents. Radiation exposure can also be avoided by studying the placement of K-wires through direct visualization of the altered 3D-printed matrix. REFERENCE: 1. Brichacek M, Diaz-Abele J, Shiga S, et al. Three-dimensional printed surgical simulator for Kirschner wire placement in hand fractures. Plast Reconstr Surg Glob Open. 2018;6:e1706.

Juvenile Osteochondritis Dissecans (JOCD) Retroarticular Drilling: Position Assessment Technique

Juvenile osteochondritis dissecans (JOCD) is an acquired condition of the joint that affects the articular surface and the subchondral bone in skeletally immature patients. Retroarticular drilling is an accepted option for stable knee JOCD when conservative treatment fails. The primary limitation of this technique is the requirement for fluoroscopy and its associated radiation. Intraoperative fluoroscopy can be a challenge because of the superimposed radiographic density of the musculoskeletal structures that may obscure visualization of the lesion in the lateral view. Consequently, most surgeries require multiple shots for the identification of the lesion and Kirschner-wire placement. We describe a new location assessment system that can, therefore, allow surgeons to more accurately identify the JOCD lesion during retroarticular drilling using radiographic landmarks. This technique may help avoid excessive intraoperative radiation and expedite intervention during the retroarticular drilling of osteochondritis dissecans lesions.

A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip.

We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip.From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well.All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage.Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.

Modified anteromedial and anterolateral elbow arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation.

Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications to the standard anteromedial (AM) and anterolateral (AL) portals could allow screw placement for radial head fracture osteosynthesis closer to the plane of the radial head articular surface. Eight fresh-frozen specimens were prepared to mimic arthroscopic setting. Standard AL (ALst) and AM (AMst) and distal AL (ALdi) and AM (AMdi) portals were established. Eleven independent examiners were asked to indicate the optimal trajectory, when aiming to place a cannulated screw parallel to the radial head surface for radial head osteosynthesis. A three-dimensional digital protractor was used to measure the angle between the indicated position and a Kirschner wire placed parallel to the radial head articular surface (α). The Shapiro-Wilk normality test was used to evaluate the normal distribution of the samples. Means, standard deviations, and 95% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. Mean α angles were 25.1 ± 11.5° for AMst, 13.8 ± 4.8° for AMdi, 17.1 ± 13.4° for ALst, -2.6 ± 9.2° for ALdi. No overlapping in the 95% CI of ipsilateral standard and distal portals was observed, indicating that the difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%). The use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL elbow arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.

3D augmented reality visualization for navigated osteosynthesis of pelvic fractures

Despite great advances in the development of hardware and software components, surgical navigation systems have only seen limited use in current clinical settings due to their reported complexity, difficulty of integration into clinical workflows and questionable advantages over traditional imaging modalities. Development of augmented reality (AR) visualization for surgical navigation without the need for infrared (IR) tracking markers and comparison of the navigation system to conventional imaging. Novel navigation system combining acone beam computed tomography (CBCT) capable C‑arm with ared-green-blue depth (RGBD) camera. Testing of the device by Kirschner wire (K-wire) placement in phantoms and evaluation of the necessary operating time, number of fluoroscopic images and overall radiation dose were compared to conventional x‑ray imaging. We found asignificant reduction of the required time, number of fluoroscopic images and overall radiation dose in 3D AR navigation in comparison to x‑ray imaging. Our AR navigation using RGBD cameras offers aflexible and intuitive visualization of the operating field for the navigated osteosynthesis without IR tracking markers, enabling surgeons to complete operations quicker and with alower radiation exposure to the patient and surgical staff.

Three-dimensional Printed Surgical Simulator for Kirschner Wire Placement in Hand Fractures.

Closed reduction and percutaneous pinning (CRPP) of hand fractures can be a deceptively challenging procedure that requires significant hands-on time to teach and learn. We created a realistic three-dimensional simulator that can be used for teaching junior residents the CRPP. Computer-aided design and computer-aided manufacturing (CAD/CAM) software was used to create a three-dimensional hand model incorporating several common hand fractures: Bennett's fracture, transverse fifth metacarpal neck, and transverse second proximal phalanx. Three-dimensional printing was used to create molds in which the bones and soft tissue were poured. A polyurethane foam was utilized for the bones with iron incorporated to render them radiopaque, whereas silicone of varying viscosities was used for the soft tissues. Five plastic surgery residents and 5 consultants evaluated the model. Individuals then completed an anonymous 12-question survey evaluating the model based on realism, educational utility, and overall usefulness. Survey responses obtained from both residents and consultants were strongly in favor of the simulator. Average realism was graded as 4.48/5 by residents and 4.68/5 by consultants. Average educational utility was graded as 5/5 by residents and 4.95/5 by consultants. Average overall usefulness was graded as 5/5 by both groups. We created an anatomically accurate and realistic simulator for CRPP of hand fractures that was low cost and easily reproducible. Initial feedback was encouraging in regard to realism, educational utility, and overall usefulness.

Anatomic Assessment of K-Wire Trajectory for Transverse Percutaneous Fixation of Small Finger Metacarpal Fractures: A Cadaveric Study.

The purpose of this cadaveric study is to evaluate the trajectory of percutaneous transverse Kirschner wire (K-wire) placement for fifth metacarpal fractures relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for the treatment of fifth metacarpal fractures. Using 12 unmatched fresh human upper limbs, we evaluated the trajectory of percutaneous transverse K-wire placement relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for treatment of fifth metacarpal fractures. The midpoint of the small and ring finger metacarpals in the sagittal plane was identified at 3 points. At each point, a K-wire was inserted from the small finger metacarpal into the midpoint of the ring finger metacarpal ("center-center" position). The angle of the transverse K-wire relative to the table needed to achieve a center-center position averaged 20.8°, 18.9°, and 16.7° for the proximal diaphysis, middiaphysis, and the collateral recess, respectively. Approximately 80% of transversely placed K-wires obtained purchase in the long finger metacarpal. These results can serve as a guide to help surgeons in the accurate placement of percutaneous K-wires for small finger metacarpal fractures and may aid in surgeon training.

Surgical treatment of isolated acute dislocation of the distal radioulnar joint without fracture: Case reports of dorsal and volar dislocations

Distal radioulnar joint (DRUJ) dislocation without fracture is uncommon. Herein, we present three cases that were treated surgically and followed for a mean of 24 months. Symptoms of DRUJ dislocation without fracture may vary, so clinical suspicion for this injury should increase whenever there is a history of wrist trauma and evidence of restricted or painful forearm supination or pronation. Radiographic evaluation may be more accurate than physical examination for diagnosis. Surgical therapy with arthroscopy-assisted closed reduction and percutaneous Kirschner wire placement yields favorable clinical and functional results.

Surgical Reduction and Fixation of Tibial Spine Fractures in Children: Arthroscopic Suture Fixation.

The pediatric tibial spine fracture can be considered the equivalent of the pediatric anterior cruciate ligament (ACL) rupture, especially considering that failure to manage these injuries appropriately could result in substantial knee pathology and long-term functional failure. Arthroscopy-assisted internal fixation of the tibial spine fracture minimizes the patient's hospital stay compared with that associated with an open arthrotomy approach, but the postoperative rehabilitation may be paramount to a successful outcome. Compared with conservative management, surgical reduction and fixation of these fractures decreases the risks of comorbidities related to meniscal tissue entrapment, the risk of anterior impingement, and the need for revision treatment. Repair should be considered for fractures displaced >5 mm at their maximum, given the risk of revision when these cases are treated without surgery. After reduction and tentative fixation, the fracture can be managed with either suture or screw fixation. For suture fixation, the surgical steps include (1) creation of peripatellar arthroscopy portals; (2) evacuation of the hematoma and clearing of the fracture bed of meniscus and callus; (3) reduction, with particular attention paid to articular surface extension if present, and tentative fixation with an ACL tibial guide and placement of threaded Kirschner wire; (4) drilling of bone tunnels for suture passage using the tibial guide juxtaposed to the ACL insertion (both medially and laterally, in turn); (5) passing a suture of choice (nonabsorbable type requiring intraoperative fluoroscopy to evaluate tunnel placement during the previous step); (6) passage of suture both posterior and anterior to the ACL fibers; (7) removal of the tentative threaded Kirschner wire; (8) tying of the posterior suture over a bone bridge; (9) tying of the anterior suture over the same bone bridge; and (10) standard arthroscopy portal closure and placement of dressings including immobilization of the knee. For screw fixation, the surgical steps are slightly different, with Step 3 followed by (4) placement of the guidewire (if a cannulated screw is being used), (5) intraoperative assessment of the fracture reduction and drilling of the screw track perpendicular to the vector of the ACL pull and tentative threaded Kirschner wire fixation, (6) measurement and placement of the final screw implant, (7) removal of the tentative Kirschner wire fixation prior to final setting of the screw, and (8) standard arthroscopy portal closure and placement of dressings including immobilization of the knee. Radiographic and functional outcomes are excellent with either fixation technique in this pediatric population.

Electromagnetic navigation for percutaneous guide-wire insertion: Accuracy and efficiency compared to conventional fluoroscopic guidance

The combination of electromagnetic (EM) navigation with intraoperative fluoroscopic images has the potential to create the ideal environment for spinal surgical applications. This technology enhances standard intraoperative fluoroscopic information for localization of the pedicle entry point and trajectory and may be an effective alternative to other image-guided surgery (IGS) systems. This study was performed to assess the accuracy and time efficiency (placement and fluoroscopy) using EM navigation versus conventional fluoroscopy in the placement of pedicle guide-wires. Kirschner wire (K-wire) placement was performed in cadavers from T8 to S1 using EM navigation versus conventional fluoroscopy. Time for set-up, placement, and fluoroscopy was recorded. After insertion, the accuracy for each level was assessed for the presence and location of facet joint, pedicle, or vertebral cortical perforation using computed tomography imaging with multiplanar reconstructions. K-wire placements were 100% successful for both methods. Comparing EM-based IGS-assisted placement with the conventional fluoroscopy method showed a longer set-up time of 9.6 min versus 3.6 min, respectively. However, mean placement times of 6.3 min versus 9.7 min ( P = 0.005) and mean fluoroscopy times of 11 s versus 48 s ( P < 0.0001) were both shorter for the EM group. There were no significant differences in the proportion of pedicle, vertebral body, or facet joint breaches. A higher proportion of ideal trajectories was achieved in the EM group. Therefore, we have shown that an EM IGS system can assist the spine surgeon in minimally invasive pedicle screw insertion by providing high-accuracy K-wire placement with a significant reduction in fluoroscopy time.

Kirschner wire placement in scaphoid bones using fluoroscopic navigation: a cadaver study comparing conventional techniques with navigation

During scaphoid fixation, a pin guide is first inserted along the axis of the scaphoid, and then a cannulated screw is inserted around the pin guide. At least, the pinguide is removed. To verify the position of the pin guide, fluoroscopy is typically used, with the disadvantage of irradiation. Thus, it is impossible to visualize the pin guide in more than one view simultaneously. The goal of this study was to compare two pin guide placement techniques in scaphoid fixation: conventional (CF) vs. fluoroscopic navigation (FN). Eleven upper limbs of cadavers were divided into two groups. The CF group included four scaphoids which were to be fixed with pin guide. The FN group included seven scaphoids which were to be fixed with the same technique under FN. The accuracy of screw insertion in both groups does not differ. In the CF group, the X-ray exposure time is four times higher. The total duration of the surgical procedure is slightly higher in the FN group. We are of the opinion that FN could be applied in clinical practice and could offer significant benefits in the treatment of fixation of the scaphoid.

Right ventricular penetration and cardiac tamponade as a late complication of Kirschner wire placement in the sternoclavicular joint

A 44-year-old woman was admitted to the emergency service with dyspnea, chest pain, and vomiting. Cardiac tamponade due to right ventricular penetration of a Kirschner wire was detected as a late complication of wire placement in the sternoclavicular joint. Clinicians should be aware of wire migration with cardiac penetration as a late complication of Kirschner wire placed in any part of the body.

Closed Reduction Transarticular Kirschner Wire Fixation Versus Open Reduction Internal Fixation In The Treatment Of bennett's Fracture Dislocation

Thirty two patients with fracture dislocations of the base of the thumb metacarpal with a single large fracture fragment (Bennett's fracture) were either treated by open reduction and internal fixation or closed reduction and percutaneous transarticular Kirschner wiring. All were assessed at a mean follow up of 7 (range 3–18) years. Patients with an articular step off more than 1 mm were excluded. The type of treatment did not influence the clinical outcome or the prevalence of radiological post-traumatic arthritis. The percutaneous group had a significantly higher incidence of adduction deformity of the first metacarpal. This was attributed to Kirschner wire placement near the fracture line or in the compression zone of the fracture, resulting in loss of reduction. This however did not result in an inferior outcome.