Kirschner Wire Group Research Articles

Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes.

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Comparison of three internal fixation methods for treatment of patellar fractures

Objective To compare patellar ring, Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures. Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016. They were 155 men and 130 women, with an average age of 45.5 years (from 18 to 70 years). Their fractures included 176 transverse, 28 longitudinal split and 81 comminuted ones. They were divided into 3 groups according to their different internal fixation methods: patellar ring fixation (98 cases), Kirschner wire tension band (92 cases), patellar ring plus Kirschner wire fixation (95 cases). The 3 groups were compared in terms of operative time, intraoperative bleeding, fracture healing time, knee function by Bostman score at the last follow-up and postoperative complications. Results The operative time in the patellar ring group(58.9±6.4 min) was significantly shorter than in the Kirschner wire group (71.8±7.8 min) and in the patellar ring plus Kirschner wire group (74.4±8.0 min) (P 0.05). The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0% (92/92), significantly higher than in the patellar ring group (90.8%, 89/98) and in the patellar ring plus Kirschner wire group (91.6%, 87/95) (P 0.05). Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures, showing the advantages of less operative invasion, fewer postoperative complications, better functional recovery of the affected knee joint, and lower price over the other 2 internal fixation methods. Key words: Patella; Fractures, bone; Fracture fixation, internal; Internal fixators; Case-control studies

Dual-Component Intramedullary Implant Versus Kirschner Wire for Proximal Interphalangeal Joint Fusion: A Randomized Controlled Clinical Trial

We undertook a multicenter, parallel treatment arm, randomized controlled trial to compare the outcomes after surgery for the treatment of lesser digital hammertoe using either a Kirschner wire or a 2-piece intramedullary, stainless steel implant for fixation of the proximal interphalangeal joint. Our primary aim was to compare the incidence of arthrodesis and complications, and our secondary aim was to compare the subjective foot-related outcomes measured using the Bristol Foot Score and the Foot Function Index, stratified by fixation group. We hypothesized that the use of the dual-component implant would result in greater patient satisfaction, a greater incidence of radiographic arthrodesis, and fewer complications after hammertoe repair. The overall mean age of the participants was 58.72 ± 13.48 (range 18 to 84) years, their mean body mass index was 30.14 ± 6.55 (range 20.7 to 46.98) kg/m2, and no statistically significant differences in the demographic variables were present between the treatment groups at baseline or during the follow-up period. Of the 91 participants, 46 (50.55%) were randomly allocated to the Kirschner wire group and 45 (49.45%) to the intramedullary implant group. No statistically significant differences were observed between the 2 fixation groups in the incidence of complications; however, the 2-piece intramedullary implant group was associated with a greater mean Bristol Foot Score and Foot Function Index score and a greater incidence of fusion.

Novel intramedullary-fixation technique for long bone fragility fractures using bioresorbable materials.

Almost all of the currently available fracture fixation devices for metaphyseal fragility fractures are made of hard metals, which carry a high risk of implant-related complications such as implant cutout in severely osteoporotic patients. We developed a novel fracture fixation technique (intramedullary-fixation with biodegradable materials; IM-BM) for severely weakened long bones using three different non-metallic biomaterials, a poly(l-lactide) (PLLA) woven tube, a nonwoven polyhydroxyalkanoates (PHA) fiber mat, and an injectable calcium phosphate cement (CPC). The purpose of this work was to evaluate the feasibility of IM-BM with mechanical testing as well as with an animal experiment. To perform mechanical testing, we fixed two longitudinal acrylic pipes with four different methods, and used them for a three-point bending test (N = 5). The three-point bending test revealed that the average fracture energy for the IM-BM group (PLLA + CPC + PHA) was 3 times greater than that of PLLA + CPC group, and 60 to 200 times greater than that of CPC + PHA group and CPC group. Using an osteoporotic rabbit distal femur incomplete fracture model, sixteen rabbits were randomly allocated into four experimental groups (IM-BM group, PLLA + CPC group, CPC group, Kirschner wire (K-wire) group). No rabbit in the IM-BM group suffered fracture displacement even under full weight bearing. In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week. The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body. IM-BM can be one treatment option for those with severe osteoporosis.

Complications Following Tension-Band Fixation of Patellar Fractures with Cannulated Screws Compared with Kirschner Wires

Displaced patellar fractures are commonly stabilized with a modified anterior tension-band construct. The goal of the current study was to compare the incidence of complications after tension-band fixation of the patella with Kirschner wires as compared with cannulated screws. We performed a retrospective cohort study of consecutive, surgically treated patellar fractures. Patients were divided into two cohorts: fractures fixed with use of Kirschner wires and fractures fixed with use of cannulated screws. The primary outcome measure was early loss of fixation that necessitated revision surgery. Secondary outcomes included early postoperative infection and the need for implant removal. Four hundred and forty-eight patellar fractures were studied. Kirschner wires were used for fixation in 315 (70%), and cannulated screws were used for fixation in 133 (30%). The incidence of fixation failure was 3.5% in the Kirschner-wire group and 7.5% in the screw group (p = 0.065). A postoperative infection occurred in 4.4% of patients in the Kirschner-wire group and 1.5% of patients in the screw group (p = 0.17). One hundred sixteen (37%) patients in the Kirschner-wire group and 30 (23%) in the screw group underwent elective implant removal (p = 0.003). After adjusting for confounding variables, a trend toward increased incidence of fixation failure with screws as compared with Kirschner wires was present (p = 0.083). Patients treated with Kirschner wires were twice as likely to undergo implant removal compared with those treated with screws (p = 0.002). Serious complications are uncommon following treatment of patellar fractures with a modified tension-band technique, with use of either Kirschner wires or cannulated screws. In both groups the rate of fixation failure was low, as was the rate of postoperative infection. Symptomatic implants, the most common complication observed, were twice as frequent in patients treated with Kirschner wires.

BIOMECHANICAL ASSESSMENT OF TENSION-BAND WIRING FOR OLECRANON FRACTURES

Tension-band wiring is the preferred method of treatment for olecranon fractures and is widely used throughout the world. This technique simply and effectively transforms the forces produced by the pulling of the triceps into forces causing compression of the fracture. Although the procedure is associated with a high union rate, the incidence of skin complications is also high. The most frequent complication is symptomatic prominence of the Kirschner wires (K-wires). The purpose of this retrospective study was to identify the optimal fixation of tension-band wiring in the treatment of olecranon fractures using biomechanical techniques. Sixty-two patients were divided into two groups: a bicortical Kirschner wire group and an intramedullary K-wire group. The migration rate of the K-wires and the union rate of fractured bone were measured in both groups. Achievement of radiographic union was similar in the two groups. However, the K-wire migration rate was higher in the intramedullary K-wire group than in the bicortical K-wire group. With appropriate surgical technique, the use of bicortical K-wires is biomechanically superior to the use of intramedullary K-wires in the treatment of olecranon fractures.

Comparison of effects of PDLLA stick and Kirschner wire for the treatment of metacarpal fractures

Objective To evaluate the clinical effects of PDLLA sticks in treatment of metacarpal fractures. Methods Twenty-five cases (28 metacarpal fractures)were performed with. Thirty-one cases( 35 metacarpal fractures) were treated with internal fixation with Kirschner wire, Comparison of curative effects of two operations were performed. Results Twenty five cases were followed up for 4 to 12 months,in PDLLA sticks group,mean healing time were 4. 6 weeks. All 25 cases fractures healed. Two cases suffered delayed union. According to the TAFS Scoring Sys-tem:sixteen cases were excellent ,6 cases were fine,3 cases were bad. The rate of excellant and good was 88% ,In Kirschner's group, the mean healing time were 7. 8 weeks. Three cases were malunion,5 cases suffered delayed union, 1 case was nonunion, the other fractures healed normally. Mean healing time were 7.8 weeks, Twenty cases were excellent, 3 cases were good, 8 cases were bad. The rate of excellent and good was 74. 2% ,There was significant difference in rate of excellent and good between two groups (P<0.05). Conclusion PDLLA sticks for the treatment of metacarpal fractures was available, do not need to remove the second operation,its effect is better than Kirschner wire group. Key words: PDLLA sticks; Kirschner wire; Metacarpal fracture; Fracture fixation internal

Biodegradable pins versus kirschner wires in hand surgery

We compared biodegradable pins with standard Kirschner wires in the fixation of fractures, arthrodeses and osteotomies in the hand in a prospective, randomized study. Eleven patients were allocated to the biodegradable pin group and 12 to the Kirschner wire group. Age, gender, operative procedure and postoperative treatment did not differ in the two groups. All patients were evaluated after 6 months. No differences in time to union or complication rates were found, but the number of additional operative procedures in the Kirschner wire group significantly exceeded the number needed in the biodegradable pin group.

Results of small-joint arthrodesis: Comparison of Kirschner wire fixation with tension band wire technique

In a retrospective study the results of 203 interphalangeal and metacarpophalangeal arthrodeses performed between 1977 and 1990 were reviewed. Eighty-three percent of the cases involved severe hand injuries. Two fixation techniques were used. During the early period, 143 arthrodeses were performed with percutaneous Kirschner wires, combined with either interosseous wiring or plaster of Paris. From 1987 to 1990, 60 arthrodeses were performed with the use of tension band fixation. In the Kirschner wire group 18% of the patients had pin-track infections, and in 15% rearthrodeses were necessary. In the tension band group 2% of the patients had an infection, and in 5% rearthrodeses were performed. Both the infection rate and the rearthrodesis rate were significantly lower in the tension band group than in the Kirschner wire group. Judging from this study, the tension band fixation technique is the method of choice for arthrodeses of the small finger joints.