Percutaneous K-wire Fixation Research Articles

Evaluation of functional outcomes of a modified technique for percutaneous pinning of proximal humeus fracture

Introduction: Proximal humeral fractures are extremely common injuries, and are one of the true osteoporotic fractures. For those that have moderate to severe displacement, the optimal treatment for the patient has not been fully elucidated. The purpose of this study was to evaluate the functional outcome of a modification of percutaneous K-wire fixation technique. Material and methods: A prospective study was performed on all patients diagnosed with intra-articular proximal humerus fracture presenting to us from June 2013 to June 2016. Only patients with closed, displaced two or three part fractures as per Neer’s classification were included in the study. Fractures were managed by close reduction and percutaneous pinning with K wires which were linked by a fixator rod using clamps. Patients were evaluated for functional outcome using the Constant score. Results: Twenty seven patients comprising of 18 females and 9 males were followed for an average period of 14 months. Mean age of the patients was 56 years. Fall while walking was the most common mode of injury followed. Mean Constant Score of patients was 77.2. All patients achieved full functional range of motion by the end of 4 months. No nerve injury was reported. Conclusion: Modified technique for percutaneous Kwire fixation using the fixator mini clamps and rods is an effective and economical method allowing biological preservation with good results.

The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3–10) preoperatively to 1.59 (range, 0–3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.

Percutaneous Kirschner Wire Versus Commercial Implant for Hammertoe Repair: A Cost-Effectiveness Analysis

Hammertoe deformities are one of the most common foot deformities, affecting up to one third of the general population. Fusion of the joint can be achieved with various devices, with the current focus on percutaneous Kirschner (K)-wire fixation or commercial intramedullary implant devices. The purpose of the present study was to determine whether surgical intervention with percutaneous K-wire fixation versus commercial intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic tree model was conducted to investigate the healthcare costs and outcomes associated with either K-wire or commercial intramedullary implant fixation. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. Our results found that commercial implants were minimally more effective than K-wires but carried significantly higher costs. The total cost for treatment with percutaneous K-wire fixation was $5041 with an effectiveness of 0.82 QALY compared with a commercial implant cost of $6059 with an effectiveness of 0.83 QALY. The incremental cost-effectiveness ratio of commercial implants was $146,667. With an incremental cost-effectiveness ratio of >$50,000, commercial implants failed to justify their proposed benefits to outweigh their cost compared to percutaneous K-wire fixation. In conclusion, percutaneous K-wire fixation would be preferred for arthrodesis of the proximal interphalangeal joint for hammertoes from a healthcare system perspective.

Midterm results after sole percutaneous treatment for central impression fractures of the base of the middle phalanx

This study investigated the midterm results after sole percutaneous treatment for central depression fractures of the base of the middle phalanx. 19 men and 2 women with an average age of 31.9 (18 - 57) years with a central depression fracture of the middle phalanx treated solely by intramedullary reposition with a bended K-wire and percutaneous K-wire fixation were followed on average of 13.2 (3 - 40) months. At the time of the last follow-up, all patients were able to pursue their previous occupational activity as well as their usual leisure activities and were painfree (VAS 0). The postoperative active flexion of the affected PIP joint was 86° with an average extension deficit of 1° or 93 % of the range of motion of the uninjured PIPJ of the opposite side. Radiologically there was a nice remodeling of the articular surface with no osteoarthrosis. There were no pin-associated complications or wound healing disorders. The sole intramedullary reduction with K-wire osteosynthesis is a suitable and reliable method for the treatment of the central impression fracture. Good functional results can be achieved with low surgical effort.

The Overcoming of Calcaneal Fractures Associated with Skin Problems through a Minimally Invasive Surgery by Closed Reduction and Percutaneous K-wires Fixation

Introduction: Calcaneus injuries account for 2% of all fractures. The surgical treatment of calcaneal fractures with skin problems is a challenge to the surgeon. Many operative techniques described for management of fractures calcaneus, ranging from minimally invasive percutaneous fixation to extensive open techniques. Material and methods: Between February 2012 and December 2015, this prospective study included forty five patients (38 male and 7 female) presented with 50 displaced calcaneal fractures associated with skin problems underwent a minimally invasive surgery by closed reduction and percutaneous k-wires fixation. Results: According to American Orthopedics Foot and Ankle Society (AOFAS) ankle hindfoot scale 37 patients had excellent, 9 patients were good and 4 patients had fair results. According to skin, the bad skin condition improved within 2 to 3 weeks postoperatively and there were no serious skin complications. Conclusion: Calcaneal fractures associated with bad skin conditions are best treated by a minimally invasive surgery by closed reduction and percutaneous k-wires fixation as there is no delay in surgery time like open procedures and there is a marvelous improvement of skin conditions.

Unstable Metacarpal Fractures: AComparative Study between Mini-Plates and Percutaneous K-Wire Fixation at Emergency Hospital, Mansoura University, Egypt

Introduction:Management of metacarpal shaft fracture is dictated by the stability and personality of the fracture. It may be conservative or surgical. Surgical management of Metacarpal fractures has different techniques and different instruments.

Clinico-radiological outcome of closed reduction and percutaneous fixation of proximal humerus fractures

Proximal humerus fracture is the commonest fracture affecting the shoulder girdle in adults and its incidence is rising. In displaced fractures, surgery is the treatment of choice in order to restore anatomical integrity, and allows early functional recovery. Several techniques were used over the years, each with specific indication. Closed reduction and percutaneous fixation reduces risk from soft-tissue dissection and may reduce the fracture indirectly, achieving provisional fixation for anatomic healing. Aim of study is to assess the clinic-radiological outcome of percutaneous pinning in proximal humerus fractures. A study group of 21 patients with Neer,s type 2 and 3 proximal humerus fracture were treated with closed reduction and percutaneous K-wire fixation and clinico-radiological assessment was done and functional outcome was assessed by Constant-Murley score in various follow ups. 17 patients were available for assessment with minimum follow up of 1 year (Range 1 to 6 year). Patients had a mean age group of 35.5 years. All patients except two showed full range of movement, radiographic healing occurred in a mean time of 10 week and K-wire removal was done at a mean interval of 12 weeks. Mean Constant-Murley score was found to be 85%. Percutaneous fixation by k-wires after closed reduction is a reliable option for management of 2-or 3-part proximal humerus fractures which also avoids plate application.

Management of supracondylar fracture humerus type 3 in children with percutaneous K-wire vs. open reduction and internal fixation with K-wire

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Aim of the study is to determine the relation between the reduction technique percutaneous pinning and open reduction and internal fixation with K-wire used in management of supracondylar humerus fractures in paediatric age group and the ultimate elbow status (functional and cosmetic), so that appropriate reduction technique can be adopted for better functional and cosmetic outcome.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Children below 12 years with Gartland’s type III supracondylar fractures managed by closed reduction and percutaneous K-wire fixation and open reduction and K-wire fixation and Flynn’s criteria was used to grade the outcome of surgical fixation. 10 Closed reduction and K-wire fixation and 10 open reduction and K-wire fixation were done</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Most of the fractures were sustained when the patient had fallen down on out stretched hand while playing or slip and fall. According to Flynn’s grading, there are 7 excellent, 2 good and 1 fair functional result observed in closed reduction and k wire fixation. There are 4 excellent, 3 good and 3 fair functional results observed in open reduction and k wire fixation with statistically significant p value 0.04</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Open reduction through lateral approach and internal fixation wire K wires is safe and effective method of treatment, if indicated, in supracondylar fractures of humerus in children and is associated with a good outcome. A small incision medially in cases where medial epicondyle cannot be defined to visualize the epicondyle and the ulnar nerve, by which iatrogenic ulnar nerve palsy in percutaneous fixation can be prevented.</span></p>

Embrochage à foyer fermé antérograde pour les fractures des métacarpiens – étude prospective sur 150 cas

The aim of the study was to asses the results of antegrade percutaneous intramedullary K-wire fixation, for unstable displaced metacarpal fractures in a large number of cases in order to support the usage of this mini invasive technique in the largest variety of fractures as possible. One hundred and fifty patients with 165 metacarpal fractures were evaluated. Average follow-up 10 weeks. TAM of the digit, rotational deformity, Q-DASH score and PRWHE score were recorded. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal. Regional anesthesia, fluoroscopic guidance and upper arm tourniquet were always used. Once the metacarpal fracture was reduced, a hole at the proximal epiphiseal dorsal corner was performed percutaneously with a pointed tip K-wire (2 mm of diameter) with an incidence of about 40°. Then, a blunt tip K-wire, was inserted through the hole in the metacarpal bone in the anterograde direction along the whole intramedullary canal until the internal cortical bone of the metacarpal head, in order to obtain a stable fixation. Number and diameter of the K-wire depend on the fracture morphotype and on the size of medullary canal. They were selected to fit in the intramedullary space well to supply maximum fracture stability, verified with dynamic test. The wires were bent approximately of 90° to be perpendicular to the dorsal skin and then cut to about 2 cm outside of it to prevent tendon impingement, which is possible with subcutaneous wire cutting. A soft dressing was applied for all the patients, encouraged to begin full motion exercises. At 5 weeks the wires were removed. Few precautions distinguish our technique over others described in the literature, but they are crucial in our opinion. Percutaneous antegrade approach without joint transfixation and tendon exposition joined to an immediate finger motion is able to avoid stiffness and tendon adhesions. The thickness of K-wires is always the largest possible to ensure rotational and length stability. Do not cut the wire under the skin, prevents tendon irritations and this leads to a very low incidence of complications such as infection, algodystrophy and need for second operations. This technique represents a valid solution for the treatment of many kind of displaced and unstable fractures of the metacarpals, being of fast running, of low cost and offering excellent results both in terms clinical and radiographic.

A comparative study of two percutaneous pinning techniques (Cross K wire vs Lateral K wire) for Gartland type III pediatric supracondylar fracture of the humerus

Background: Supracondylar fractures of humerus are one of the most common fractures in paediatric age group. Closed reduction and percutaneous K-wire fixation is one of the most commonly used treatment modality in Gartland type 3 fractures. A prospective randomized controlled study was undertaken to compare whether parallel k wires are better in terms of the stability, functional outcome and iatrogenic ulnar nerve as compared to cross k wire (medial and lateral). Material and methods: This is a prospective comparative randomized controlled trial. A total of 30 patients of displaced supracondylar fracture aged between 5-13 years, without any compound injury or comminution were enrolled for the study and randomly divided into two groups, each of 15 patients. One group was assigned treatment of crossed pinning and other group with lateral pinning respectively and outcome was evaluated on basis of pain, motion, stability and function according to Mayo’s elbow score and follow-up was maintained for a period of 45 days and statistical significance was calculated. Results: After assessment of 15 patients in each group we found out that mean mayo score was 98 in cross pinning group and 96.83 in lateral pinning group. This difference is statistically not significant. Conclusion: In our study we conclude that, lateral pinning is an equally good treatment choice in these fractures and especially for grossly swollen elbows. Also, risk of ulnar nerve injury during placement of medial pin is eliminated in lateral parallel k wires. Both the methods offer consistently satisfactory functional and cosmetic results.

Treatment of type III Acromioclavicular dislocation with open reduction and percutaneous K-wire fixation

Background: The direct force acting on the shoulder from the lateral side with the arm in an adducted position is the main mechanism of injury in the vast majority of traumatic dislocations of the acromioclavicular joint. Patients and method: Fourteen patients with an acromioclavicular separation (Rockwood type III) were surgically treated with open reduction, repair of the capsule, and percutaneous 2 K-wires fixation under image intensifier. There were 10 men and 4 women with a mean age of 37 years from 23 to 60). The surgery was done 10.2 days average after trauma (range 3–21 days). Results: The follow-up period ranged from 8 months to 30 months (Average 18 m). According to Constant score seven patients had excellent score, five good, two fair, and no poor results were obtained. Complications were two migrated K-wires five weeks postoperative were removed without influence on the final result. Superficial wound infections occurred in three cases and needed no further surgical treatment, only dressing and oral antibiotic for two weeks. Shoulder stiffness was mild in two cases and did not impair in the patient daily activities. We had no deep infections or nerve palsies. Conclusion: Open reduction, repair of the capsule, and percutaneous transfixing 2 K-wires is a valid and good method for treatment of type III Rockwood type acromioclavicular dislocation with little rate of subluxation, joint stiffness, or ligament ossification.

Percutaneous K-Wires Fixation of Displaced Intra-articular Calcaneal Fractures (A Novel Technique)

Category: Hindfoot Introduction/Purpose: The operative treatment of calcaneal fractures has been a controversial topic. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous K-wires fixation was used to preserve soft tissue. The aim of our study is to evaluate the outcome of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures. Methods: Twenty two displaced intra-articular calcaneal fractures were treated by closed reduction and percutaneous K-wires fixation. The clinical evaluation was based on Maryland Foot Score. According to Sander’s Classification, Eleven fractures were type II, nine were type III and two were type IV. Bimanual compression across the calcaneus was applied to reduce the calcaneal width. A Schanz screw was inserted into the calcaneal tuberosity and was forcibly pushed downwards to elevate the depressed fragment. Two parallel 2 mm K-wires were placed from the posterior inferior corner of the calcaneus across the posterior facet and into the talar body. The reduction of the articular surface was maintained by two crossing subchondral 2 mm K-wires. If the reduction was not satisfactory, a 1-2 cm long transverse incision was used just below the tip of the lateral malleolus. A small tipped periosteal elevator was introduced to elevate the depressed fragment before K-wire fixation. Results: The mean follow up period was 7.68 months. The clinical outcome revealed 18 fractures (81.8%) of satisfactory (14 excellent and 4 good), and 4 patients (18.2%) of unsatisfactory results (4 fair and 0 poor). The mean time of radiological union was 11.86 (range 10 – 14) weeks. One patient had pin tract infection. One patient developed heel widening. Conclusion: Closed reduction and percutaneous K-wires fixation of calcaneal fractures minimizes the soft tissue complications and postoperative scar formation. The mini approach for elevation of the depressed posterior facet restores the articular surface and decreases late subtalar arthritis.

Abstract: Outcomes of Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws: A Literature Review

INTRODUCTION: Metacarpal fractures are a common occurrence in the United States, making up 33.3% of all hand fractures. The majority can be treated nonoperatively, but surgery is indicated when fractures cannot be reduced or fracture alignment cannot be stabilized using closed methods. In 2010, Boulton et al reported intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture. This method has since been described as an operative technique for displaced, comminuted subcapital, and metacarpal neck and shaft fractures. The purpose of this review is to evaluate the recent studies reporting on the outcomes of intramedullary screw fixation of metacarpal fractures. METHODS: Pubmed, Web of Science, and Cochrane were searched. All outcome data from articles reporting on the use of intramedullary screws for the treatment of metacarpal fractures were combined. RESULTS: A total of five articles, one of which was the original case report, were identified for a total of 115 metacarpal fracture repairs performed using intramedullary screw fixation. The majority (84%) were in the small finger with fracture location in the metacarpal neck (69%). All studies used 2.4mm or 3.0mm screws ranging from 32-50mm in length for fixation. Average follow-up was 14 months with an average MCP flexion of 82 degrees (n=78). One study (n=18) did not record MCP flexion, but reported each digit to have a total active motion >240 degrees. All but one study measured radiographic union as an outcome, and all (n=78) resulted in 100% union at or before the latest follow-up. Additionally, grip strength was assessed in two studies (n=29), which showed an average of at least 98% of the contralateral hand. No serious complications were reported. Only one hardware removal was performed due to radiographic suspicion of intra-articular screw penetration. Of note this was a complication of the Y strutting technique in which two intramedullary screws are placed. CONCLUSION: Intramedullary fixation of metacarpal fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option for metacarpal fractures. Advantages of this technique over previously described methods (intramedullary nail or percutaneous K-wire fixation) include no requirement of K-wire removal and increased rotational stability, thus allowing for earlier mobilization.

Management of distal radius fractures – A new concept of closed reduction and standardised percutaneous 5-pin fixation

IntroductionManagement of distal radial fractures is a controversial topic, with poor reported outcomes in up to 30% of cases and a wide variety of treatment options such as closed reduction and POP cast, internal fixation, external fixation and percutaneous pin fixation in many configurations. Over the last 13 years, we have used a novel standardised 5-pin configuration of percutaneous K-wire fixation, which can be used in most types of distal radial fractures, where closed reduction is possible, and the ulna is intact or re-constructible. This study reports the outcomes of this technique. MethodsAll patients presenting to our unit with distal radial fracture in a 126-month period from June 2005 to December 2015 managed by closed reduction and 5-pin fixation were evaluated for complications including wire loosening and infection, tendon or nerve injury, reflex sympathetic dystrophy and functional outcome. ResultsA total of 490 consecutive patients with 496 distal radial fractures were treated in the study period with a mean age of 49.4 years; 57% were female and 57% were due to domestic falls. After death from unrelated causes and loss to follow-up, 418 patients were reviewed in clinic, and a further 40 were patients contacted by telephone at one year, and clinical outcome was evaluated using Cooney’s modification of Green and O’Brien’s score. All fractures healed and 95.7% had an ‘excellent’ outcome and 3.9% were ‘good’; only two patients achieved a ‘fair’ outcome, both of whom had comminuted intra-articular fractures with metaphyseal comminution. Complications were minimal and temporary with no cases of deep infection, tendon or nerve injury or reflex sympathetic dystrophy. ConclusionsThis study proved that our novel customised 5-pin percutaneous fixation was sufficiently stable and controlled all fragments of distal radial fractures effectively to allow early mobilisations to prevent stiffness and reflex sympathetic dystrophy with excellent functional outcomes.

Transradial Styloid Perilunate Dislocation: A Rare Case

Although perilunate fracture-dislocation usually extremely alters the inter-carpal relationships, it is frequently misinterpreted during initial evaluations. We report two 30-year-old males with a very rare transradial styloid perilunate fracture-dislocation treated by closed reduction and percutaneous K-wire fixation. They regained the range of motion (ROM) of their wrists and furthermore, the mid-term outcome turned out to be satisfactory

Functional outcome of proximal humerus fracture treated with philos plate

Proximal humerus fractures are the third most common nonvertebral osteoporotic fracture after proximal femur and colles fractures, accounting for >10% of fractures, above the age of 65 years. Wide arrays of techniques have been described like closed reduction and percutaneous K-wire fixation, open reduction followed by fixation with transosseous sutures, tension band wire, T plate, locking plates and screws, intramedullary nails, and prosthetic replacement. The aim of our study was to assessed the functional outcome of open reduction and internal fixation by plate osteosynthesis with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures. Prospective study conducted in our medical institution between 2015 and 2016. Open reduction and internal fixation with a PHILOS plate was done under general anesthesia in 31 patients. Male patients predominated female patients (21 males to 10 females), and the average age of patients is 39 years with the range being 25–70years. Road traffic accident and fall from height were the commonest cause of the trauma (77.4%). Neer classification system was used to classify the fractures. During the follow–up functional parameters were assessed using Constant-Murley scoring system. The mean time for radiological union was 14weeks (10-21 weeks). At the final follow-up the mean Constant-Murley score was 81 (57-100). The results were excellent in 15 patients, good in 7 patients, fair in 5 patients and poor in 4 patients. To conclude that PHILO plating is a safe and effective treatment for proximal humerus fractures.

Treatment of Gartlands Type II and Type III Supracondylar Fracture Humerus by Closed Reduction And Percutaneous K-wire Fixation

Treatment of Gartlands Type II and Type III Supracondylar Fracture Humerus by Closed Reduction And Percutaneous K-wire Fixation

Treatment of displaced flexion-type pediatric supracondylar humeral fractures in the prone position.

This study is to report a new method to reduce and fix the displaced flexion-type pediatric supracondylar fracture in the prone position. Ten children with displaced flexion-type supracondylar humeral fractures treated between 2007 and 2013 were reviewed. There were three girls and seven boys, with a mean age of 9.5 years. The fracture was reduced by gentle traction of the forearm and gradual extension of the elbow in the prone position. Two or three crossed Kirschner wires (K-wires) were inserted percutaneously to secure the fracture reduction. Radiographic evaluation included the Baumann's angle and the lateral humerocapitellar angle. Clinical outcomes were assessed using the Flynn's criteria. Eight children had closed reduction and percutaneous K-wire fixation. The other two children required open reduction through a posterior triceps splitting approach. The mean Baumann's angle was 70.2° immediately after K-wires fixation and 69.5° after 3 months later. The mean lateral humerocapitellar angle was 38° immediately after K-wires fixation and 35.5° after 3 months later. The clinical outcome was excellent in nine children and poor in one child by the Flynn's criteria. Reduction of displaced flexion-type pediatric supracondylar humeral fractures by traction and gradual extension in the prone position is an effective and safe method. When reduction is still impossible or nerve incarceration is suspected, open reduction and release of the trapped nerve through a posterior triceps splitting approach are simply accessible.

Comparison of open reduction internal fixation with proximal humerus interlocking system and close reduction and pinning with K-wire in proximal humeral fracture

Introduction: Fracture of the proximal humerus represents the second most common fracture in upper extremity. The indications of surgery continue to expand due to improvement in internal fixation techniques. Aim: This study aimed to compare the result of open reduction internal fixation with proximal humerus interlocking system and close reduction and pinning with K-wire in these fractures. Materials and Methods: This study included 48 cases which were divided into two groups by randomized controlled trial type of study design, 24 patients (Group A) were operated with proximal humerus internal locking system (PHILOS) and 24 patients (Group B) with percutaneous K-wire fixation. All the 48 patients were followed up for a mean duration of 11 months. Final evaluation was done according to Neer's (1970) criteria. Results: All fractures united with an average of 10.34 weeks. Union time between the groups was statistically insignificant. In Group A, 83.33% of cases had favorable results against 50.0% of Group B and difference was significant. In Group A, mean Neer's score was 86.0 and in Group B it was 77.7 and difference was significant. In Group A, mean Neer's score for range of motion (ROM) was 20.75 and in Group B it was 17.25 and difference was significant. Ten complications (subacromial impingement-1, screw perforation-1, infection-1, malunion-2, stiff shoulder-3, and pain in shoulder-2) were seen in six patients (25%) treated with PHILOS and 17 complications (K-wire migration-2, infection-2, malunion-4, stiff shoulder-6, and pain in shoulder-3) were seen in 10 patients (41.1%) fixed with K-wire. Conclusion: In patients of 2-part and 3-part displaced proximal humerus fractures, results are almost equivocal. However, mean Neer's score for ROM was significantly more in patients treated with PHILOS. In 4-part fracture and patients of age >50 years, results of PHILOS are significantly better than K-wire.

Mini approach and percutaneous fixation of intra-articular calcaneous fractures

Introduction Intra-articular calcaneous fracture is one of the most aggravating fractures if not properly managed. Open reduction and internal fixation are associated with high incidence of postoperative soft-tissue complication. Closed reduction and percutaneous fixation had a high incidence of postoperative subtalar osteoarthritis due to an improper reduction of the articular surface, and therefore the mini approach was used for restoring the articular surface and for fixing the fracture by K-wires.Patients and methods A total of 22 patients with 27 intra-articular calcaneous fractures from March 2009 to July 2012 were treated at Menoufia University Hospital. All patients were treated with the miniapproach and percutaneous K-wire fixation for intra-articular calcaneous fractures. The patient sample included 15 males and seven females. In 14 patients, the fractures were caused by falling from heights, whereas in eight patients the cause was road traffic accidents. Five patients had bilateral fractures. According to Sander’s Classification, 13 fractures were of type II, 10 were type III, and four were type VI.Results The average age was 29 years with a range of 21–55 years. The mean follow-up period was 16 months with a range of 12–36 months. The average union period of fractures was 12 weeks, ranging from 10 to 16 weeks. Seven patients had wedge fracture of the dorsolumbar spine but without neurological manifestation. The average operative time was 53 min with a range of 37–109 min. The clinical results according to the Maryland foot score revealed 21 (78%) cases with satisfactory scores (eight excellent and 13 good) and six cases (22%) with unsatisfactory results (four moderate and two poor).Conclusion Percutaneous treatment of fracture calcaneous minimizes soft-tissue complications and postoperative scar formation, which improves functional outcome. The miniapproach for elevation of depressed posterior facet restores joint congruity and decreases late subtalar arthritis.