Longitudinal K-wires Research Articles

Trapeziometacarpal Arthrodesis Using a Combination of Chevron Osteotomy, Longitudinal K-wire, and K-wire Compression Staples.

Among surgical methods for advanced trapeziometacarpal arthrosis, arthrodesis may benefit high-demand patients such as laborers because it preserves the osseous foundation of the thumb. The authors achieved successful trapeziometacarpal arthrodesis in 3 patients by a combination of chevron osteotomy, longitudinal K-wire, and K-wire compression staples without using bone graft. There were no complications specifically associated with the surgery other than asymptomatic slight pull-out of a staple. This combination is a good option for trapeziometacarpal arthrodesis, having the advantages of using a small incision and common devices and being low cost. [Orthopedics. 2018; 41(6):e894-e896.].

Analysis of Bone Fixation Methods in Digital Replantation.

BackgroundAdequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation.MethodsA single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups.ResultsThe exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%).ConclusionsIn this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

Olecranon Osteotomy With Tension Band Wire Repair.

The purpose of this video is to demonstrate the surgical technique of olecranon osteotomy with tension band wire repair. A patient with a comminuted, intra-articular distal humerus fracture requiring ORIF is presented in this video demonstration of the surgical technique of an olecranon osteotomy. The olecranon osteotomy is an established technique for approaching the distal humerus for surgical repair of fracture. In the video, the patient is positioned laterally allowing a dorsal incision. The ulnar nerve is identified and protected. A chevron osteotomy, apex distally based, is created in the proximal ulna using osteotomes, centering the osteotomy within the sulcus of the proximal ulna. Once the osteotomy has been completed, the proximal ulna is reflected proximally to allow access to the distal humerus. The osteotomy is repaired using a tension band wire technique. The 2 longitudinal K-wires (0.062 inches) engage the volar cortex of the ulna and the tips of the pins are buried beneath the triceps tendon. A figure 8, 18-gauge cerclage wire is twisted to compress the osteotomy site at the end of the procedure to promote stability and healing. The video is 10 minutes, 30 seconds duration in time and 2,048,409,000 bytes in size. Various techniques of olecranon osteotomy have been described. The principles of a well-centered osteotomy and a stable repair are essential to this technique. This is demonstrated in the video of an olecranon osteotomy using osteotomes and a tension band repair.

Biomechanical Analysis of Internal Fixation Methods for Distal Interphalangeal Joint Arthrodesis.

The biomechanical performance of distal interphalangeal joint (DIPJ) fixation techniques in response to cyclic and load-to-failure bending loads is generally unknown. The purpose of this study is to assess the performance of 4 commonly used techniques for DIP arthrodesis. Phalanges were fixed by one of the following techniques: (1) 2 parallel Kirschner wires (K-wires), (2) 1 longitudinal K-wire and 1 oblique K-wire, (3) an Acutrak® 2 Micro headless compression screw, or (4) 90-90 wiring. The phalanges were loaded in cantilever bending on the palmar side of the phalange for 3000 cycles, then loaded-to-failure. The 90-90 wiring was significantly worse than the other 3 methods in 9 of 10 parameters analyzed. Both K-wire methods and the screw produced similar results in nearly all parameters. Given the lack of difference in biomechanical performance between K-wires and compression screws, consideration should be given to other factors such as cost and complication profiles when choosing an implant for DIPJ fusion.

BILATERAL THUMB METACARPOPHALANGEAL JOINT FUSIONS FOR SEVERE HYPEREXTENSION DEFORMITIES IN CONJUNCTION WITH CARPOMETACARPAL JOINT RECONSTRUCTIONS

Hyperextension of the first metacarpophalangeal (MCP) joint and adduction of the first web space of the hand are features of advanced stages of carpometacarpal (CMC) joint arthrosis. Restoration of mechanical efficiency in such patients requires stabilization of both the CMC and MCP joints. This study describes a patient with bilateral secondary hyperextension of the MCP joint greater than 50° who displayed good functional outcome following staged bilateral MCP joint arthrodesis with simultaneous CMC joint reconstruction. Excision of trapezium, formation of a Weilby sling utilising flexor carpi radialis, and insertion of a Swanson's prosthesis forms the basis of CMC joint reconstruction. Fusion of the MCP joint involved placement of longitudinal K-wires and tension band wiring. The patient underwent an initial right-sided procedure in 2008 and subsequently elected for the same procedure on the contralateral side 26 months later. Good functional improvement was achieved with a pre and postoperative DASH score of 49 and 8 respectively. Follow-up and radiological imaging at 34 months from her initial surgery confirmed good positions of the prostheses and solid MCP joint fusions. The patient developed postoperative interphalangeal joint pain, which responded to steroid injection. There is currently limited evidence available addressing the management of severe hyperextension deformity greater than 50° of the MCP joint in the presence of CMC joint arthrosis. Staged bilateral fusion of the MCP joint and simultaneous CMC joint reconstruction in this case illustrates good, reproducible functional results and patient satisfaction with reduced postoperative return to function.

Long term outcome of patella fractures:open reduction and internal fixation with stainless steel wire vs.non-absorbable braided polyester suture

Objective To determine the long term outcome of patella fractures managed surgically with two different types of fixation:stainless steel wire or non-absorbable,braided,polyester suture.Design A prospective trial where patients were recruited in a consecutive fashion between the years 2000 and 2005 and randomized into 2 treatment groups through random number generation and number assignments in sealed envelopes.Patients were blinded to the treatment group assigned.Surgical technique and post-operative protocol was the same for each group.Subjects Patients were over the age of 16 and medically fit who presented with a displaced patella fracture requiring operative fixation.Patients were able to give consent and could follow post-operative rehabilitation requirements.Interventions In the 2 groups,open reduction and internal fixation of the patella fractures was standardized with 2 longitudinal K-wires and a figure of eight tension band using either 18 G stainless steel wire or 2 #5 ethibond sutures.Outcome Measures The primary outcome measure was re-operation rate.Secondary outcomes included surgical procedure time,the presence of clinical and radiographic union,and validated functional outcome measures (knee questionnaire,Euroqol EQ-SD,SF-36)collected from patients at final follow up.Results Almost all patients were followed to clinical and radiographic union(20/22).Average follow-ups for the stainless steel wire and suture groups were 4 and 2.3 years respectively.The re-operations in the wire and suture groups was 4 (of 11)and 5(of 11)respectively.The majority of re-operations were due to longitudinal K-wire related irritation (6/9).The wire group had a slightly shorter average surgical time than the suture group(33 vs.44 minutes),which was not statistically significant.Long term functional outcome scores indicated that there was some residual disability in patellar fracture patients,although this was not debilitating.Conclusions We suggest that a major determinant of re-operation for patella fracture fixation in a tension band technique is unnecessary longitudinal K-wire length.Suture can be as good as wire in achieving clinical and radiographic union of patella fractures.Patients with patellar fractures can achieve a reasonable functional outcome but will have a high chance of re-operation during their recovery period. Key words: Patella; Fractures; Treatment outcome; Bone wires; Sutures

Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: A comparative study

The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal. We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method. We found the distance from the centre of the medullary canal, the range and standard deviations of K-wire positions to be significantly more precise when the jig was used. This has applications for the use of the device, both with standard metallic radio-opaque wires and potentially with bio-absorbable pins.

Assessment of Thumb Metacarpophalangeal Joint Arthrodesis Using a Single Longitudinal K-Wire

To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review. Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint. Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion. Therapeutic IV.

Time Course of Magnetic Resonance Images in an Adolescent Patient With Kienböck’s Disease Treated by Temporary Scaphotrapezoidal Joint Fixation: A Case Report

Kienböck's disease in a 15-year-old girl was treated successfully by temporary scaphotrapezoidal joint fixation using longitudinal K-wires. Repeated magnetic resonance imaging begun 3 months after surgery showed progressive increases in signal intensity on T1-weighted sequences of the lunate and was almost normal 6 months after surgery. The K-wires used for the temporary joint fixation were removed 6 months after surgery. The signal intensity of the lunate on magnetic resonance images remained normal 2 years after surgery. At that time plain x-ray showed no sign of lunate sclerosis and there was no cystic shadow or sign of advanced collapse. At 2 years after surgery the patient does not complain of wrist pain, can lead a normal daily life, and plays sports without difficulty. Therapeutic, Level IV.

COMBINED SECOND AND THIRD TOE TRANSFER: CURRENT PRACTICE

A ten-year experience of combined second and third toe transfer is described. The length, position, and the web space are important considerations during planning. To preserve bone and skin for the donor foot, these tissues should be reconstructed with groin flap and bone block beforehand. During operation, special attention should be paid to the exact design of incision, retrograde dissection of the metatarsal artery, tight extensor repair and longitudinal K-wire, to prevent clawing and wound closure before vascular anastomosis. Passive mobilization and sensory re-education should begin early.

Replantation in children

The authors have replanted 162 parts in 120 children over the past 15 years. The youngest patient, undergoing successful replantation, was aged 7 months, 3 weeks. Unlike an adult, any child suffering a traumatic amputation should be considered for a possible replantation. Replantation should consist of minimal bone shortening to preserve epiphyseal plates, with repair of all severed structures. Longitudinal K-wires usually provide adequate fixation. Our survival rate for complete replantation in children under the age of 16 years is 77%. Long-term study showed that continued skeletal growth occurred and the digit attained 81% of normal longitudinal length at maturity. Recovery of sensibility in the replanted digit is nearly as good as for isolated digital nerve repair. Patient and parent satisfaction is high when replantation is successful, with uniform approval of the extensive effort required.