Percutaneous K-wire Research Articles

Comparison of radiological, clinical, and functional results of Jakob type 2 lateral condyle fractures treated with closed reduction and percutaneous pinning versus open reduction and K-wire fixation.

Pediatric humerus lateral condyle fractures (PHLCF) are one of the most common fractures among children. PHLCF is approximately 20% of all pediatric elbow fractures. Among the treatment modalities are: nonoperative treatment with splinting, closed reduction with percutaneous K-wire fixation (CRPP), and open reduction with K-wire fixation (ORIF). We aimed to evaluate radiological, functional, and clinical outcomes of Jakob type 2 PHLCF treated either with CRPP or ORIF. We hypothesized that CRPP may be as safe and effective as ORIF for Jakob type 2 PHLCF. In this retrospective study, we included patients with Jakob type 2 PHLCF operatively treated in a single center. Patients with multiple fractures or open fractures were excluded from the study. 69 patients between ages 2 and 12 were included and they were divided into two groups. Group 1 included the patients treated with CRPP, whereas Group 2 included the patients treated with ORIF. Demographical, radiological, clinical, and functional parameters were evaluated. Average duration of surgery ( P < 0.001), initial displacement ( P = 0.014), and duration of admission ( P < 0.001) were significantly less in group 1. Group 2 had significantly higher percentage of left-sided injury than group 1 ( P = 0.038). Average varus deformity score was significantly higher in group 1 ( P = 0.014). CRPP was associated with shorter duration of surgery and hospital stay. Functional, clinical, and radiological outcomes were identified similar between CRPP and ORIF for Jakob type 2 PHLCF. CRPP may be as safe and effective as ORIF for Jakob type 2 PHLCF.

A comparative study of functional outcome of percutaneous kirschner wire fixation versus philos plating of proximal humerus fractures

: Proximal humerus fractures, accounting for approximately 5% of all fractures, pose a significant challenge in orthopedic management due to their complex anatomy and diverse fracture patterns. Treatment options range from conservative methods to various surgical interventions, each with its pros and cons. This study specifically compares two commonly employed surgical techniques: Open reduction &amp; internal fixation with PHILOS plate and percutaneous k-wire fixation with/without external clamps. This study aims to address the effectiveness of each technique by evaluating functional outcomes using validated scoring systems like the Constant-Murley Score. To assess the functional outcomes of two surgical treatment methods (K-wire application and PHILOS plate fixation) for proximal humerus fractures. : A randomized prospective study was conducted on patients coming to the Orthopaedics outpatient department or casualty of tertiary care hospital for a duration of 1 year from Dec 2022 to Nov 2023. A total of 18 patients were included in the study. The mean Constant- Murley Score (CMS) was 81 +/- 6.13 for the PHILOS plating group and 76.88 +/- 7.37 for the K-wire treated group with a p-value of 0.08. The results for CMS were excellent in 22.2% of patients and good in 66.7% of patients in PHILOS treated group and excellent for 11.11%, good for 66.67% and satisfactory for 22.2% in the K-wire treated group. Both groups achieved satisfactory functional outcomes with CM Score at the final follow-up. Both techniques achieved favorable outcomes, with a majority of patients in both groups (88.89% for PHILOS and 77.78% for K-wire) achieving good to excellent results based on the CMS scores.

The Safety of Volar to Dorsal Percutaneous Screw Fixation of Bennett Fracture-Dislocation - A Cadaveric Study.

Background: Bennett fractures are traditionally fixed with percutaneous K-wires from dorsal to volar, or with a volar to dorsal screw via a volar open approach. While volar to dorsal screw fixation is biomechanically advantageous, an open approach requires extensive soft tissue dissection, thus increasing morbidity. This study aims to investigate the practicality and safety of Bennett fracture fixation using a percutaneous, volar to dorsal screw, particularly with regard to the median nerve and its motor branch during wire and screw insertion. Methods: Fifteen fresh frozen forearm and hand specimens were obtained from the University of Auckland human cadaver laboratory. A guidewire is placed under image intensifier from volar to dorsal with the thumb held in traction, abduction and pronation. The wire is passed through the skin volarly under image intensifier, then the median nerve is dissected from the carpal tunnel and the motor branch of the median nerve (MBMN) is dissected from its origin to where it supplies the thenar musculature. The distance between the K-wire to the MBMN is measured. Results: In 14 of 15 specimens, the wire was superficial and radial to the carpal tunnel. The mean distance to the origin of the MBMN is 6.2 mm (95% CI 4.1-8.3) with the closest specimen 1 mm away. The mean closest distance the wire gets to any part of the MBMN is 3.7 mm (95% CI 1.6-5.8); in two specimens, the wire was through the MBMN. Conclusions: Wire placement, although done under image intensifier, is subject to significant variation in exiting location. While research has shown the thenar portal in arthroscopic thumb surgery is safe, our guidewire needs to exit further ulnar to capture the Bennett fracture fragment, placing the MBMN at risk. This cadaveric study has demonstrated the proposed technique is unsafe for use.

Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation

Background: Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to evaluate outcomes in the management of fracture separation of the distal humeral epiphysis treated seven or more days post-initial injury. Methods: A retrospective analysis was conducted on patients diagnosed with fracture separation of the distal humeral epiphysis between November 2016 and October 2023. Inclusion criteria encompassed patients with delayed presentation of fracture separation of the distal humeral epiphysis who underwent surgical intervention seven or more days following the initial injury. Demographic data were collected, and fractures were categorized using the modified DeLee classification. Plain radiographs facilitated the assessment of the carrying angle and postoperative Baumann angle. Clinical outcomes were evaluated using the Flynn criteria. Results: The study included 12 patients who met the inclusion criteria. The average age at the time of injury was 1.59 years. According to the modified DeLee system, fracture classification identified one type I fracture, eight type II fractures, and three type III fractures. The average duration from injury to surgery was 11.8 days. The mean surgical duration was 21.5 min. The average follow-up period was 40.7 months. One patient exhibited cubitus varus development. Based on the Flynn criteria, outcomes were as follows: seven patients had excellent outcomes, four had good outcomes, and one had a poor outcome. Conclusion: Closed reduction with percutaneous K-wire fixation represents a minimally invasive approach suitable for children diagnosed with fracture separation of the distal humeral epiphysis seven or more days post-initial injury. Most of these patients experienced favorable outcomes. Level of evidence: IV

Functional and Radiological Outcomes of Miniature Plate Osteosynthesis in Metacarpal and Phalangeal Fractures of Hand: A Prospective Study.

There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.

The Functional Outcome of Closed Reduction Percutaneous K-Wire Fixation of Type 3 Supracondylar Humerus Fractures

Background: Supracondylar fractures of the humerus are among the most common pediatric fractures, accounting for a significant portion of elbow injuries in children. The management of these fractures, especially Type III fractures which are completely displaced, poses a challenge due to the potential for serious complications and difficulties in achieving satisfactory reduction. The current standard treatment involves closed reduction and percutaneous pinning under fluoroscopic guidance. However, delays in presentation and treatment can complicate outcomes, particularly in resource-limited settings. Objective: The objective of this study was to evaluate the safety and effectiveness of closed reduction and percutaneous K-wire fixation in children presenting with Type III supracondylar humerus fractures after a delay. Methods: This descriptive case series was conducted at Lady Reading Hospital MTI, Peshawar, from February 2023 to February 2024. A total of 84 patients aged 3-10 years with Type III supracondylar humerus fractures were included. Patients with neurovascular complications at presentation, other types of fractures, or those with multiple traumas were excluded. The study utilized non-probability, consecutive sampling. Procedures were performed under general anesthesia with fluoroscopic guidance, and outcomes were assessed using Flynn's criteria. Data analysis was conducted using SPSS version 25. Results: Of the 84 patients, 45.2% were male and 54.8% were female. The age distribution was 36.9% for ages 3-5 years, 38.1% for ages 6-7 years, and 25% for ages 8-10 years. Closed reduction and percutaneous pinning were successful in 90% of the cases, with only 10% requiring conversion to open reduction. Flynn's criteria indicated that 31 patients (36.9%) achieved excellent outcomes, 23 (27.4%) good, 10 (11.9%) fair, and 20 (23.8%) poor. The rate of pin tract infection was 7.5%. Conclusion: The study concludes that closed reduction and percutaneous pinning is a safe and effective method for treating children with delayed presentation of Type III supracondylar humerus fractures. Despite the delay in treatment, the majority of patients achieved favorable functional outcomes with a low incidence of complications.

Radiographic Comparison of Open and Minimally Invasive Distal Chevron Metatarsal Osteotomy in Patients With Hallux Valgus

This study aimed to compare radiographic outcomes of open and minimally invasive surgery (MIS) in patients with hallux valgus. We reviewed data of patients with hallux valgus who underwent open or minimally invasive distal chevron osteotomy at our institution. Radiographic assessment was completed preoperatively, immediate postoperatively, and one year postoperatively using eight weight bearing parameters . The classic distal chevron osteotomy method was used for open surgery and a modified method that added percutaneous K-wire fixation to the minimal invasive Chevron-Akin (third-generation MIS) was used for correction of the distal metatarsal articular angle (DMAA). A total of 65 feet (33 open surgeries and 32 MIS) were included. The HVA, IMA, and DMAA improved significantly following surgery regardless of surgical method (p<0.001). Other radiographic indicators showed no statistically significant differences after surgery. DMAA improved by 71.0±14.2% after surgery, and the open surgery group showed less significant reduction in DMAA (49.7±25.7%, p<0.001). Other parameters showed no difference between the two groups regarding relative postoperative changes. The MIS group showed shorter operation time (p<0.001) and hospitalization period (p=0.034) than did the open surgery group. Therefore, the MIS group is expected to be cost-effective. Radiographic measurements revealed comparable outcomes of MIS compared with open surgery. Additionally, adding percutaneous K-wire fixation during MIS had an advantage in correcting DMAA compared with open surgery. Furthermore, the correction of DMAA could reduce recurrence of valgus deformity of the hallux.

Comparison of outcomes in buried versus exposed Kirschner wire for treatment of paediatric supracondylar humerus fracture

Introduction: The treatment options for paediatric supracondylar distal humerus fractures include close reduction and above elbow slab application, close reduction and percutaneous K-wire fixation, and open reduction and internal fixation using K-wire. For displaced supracondylar fracture closed reduction and percutaneous K-wire fixation, under C-arm guidance, is the current gold standard treatment option. Leaving the K-wire exposed or buried under the skin is decided as per the discretion and convenience of the operating surgeon. Objectives: The objective of this study is to evaluate and compare the outcomes of buried and exposed K-wire for treatment of paediatric supracondylar humerus fractures. Methodology: This study is a prospective, comparative, observational study conducted among the paediatric patients visiting Birat medical college teaching hospital OPD/ emergency department with supracondylar humerus fracture. The sample size was calculated to be 90 (45 in each group) on the basis of convenience sampling and samples were collected using systematic random sampling technique. After data collection, all reports are entered in a predetermined Performa and analysed using SPSS version 21. Results: The overall complications rate was 20%. In the exposed K-wire group, 6 patients (13.33%) had surgical site infection at 4 weeks. Among them, 5 patients (11.11%) had superficial infection and 1 patient (2.22%) had deep infection. In the buried K wire group, only 2 patients (4.44%) had skin perforation and superficial infection. None of the patients had deep infection. There were 2 patients (4.4%) with hyper granulation tissue formation in exposed K wire group which were associated with superficial infection. There were 8 patients (17.8%) with skin irritation/ K wire prominence but without K wire perforation in the buried K wire group which was statistically significant (p value 0.006). Conclusion: There is no significant difference between the exposed K wire group and buried K wire group.

The effects of postoperative malrotation alignment on outcomes of Gartland type III/IV paediatric supracondylar humeral fractures treated by close reduction and percutaneous K-wire fixation

PurposeIn this study, we aimed to investigate the effects of postoperative malrotation alignment on the outcomes of Gartland type III/IV paediatric supracondylar humeral fracture (SCHF) treated by close reduction and percutaneous K-wire fixation.MethodsBetween January 2014 and December 2021, 295 Gartland type III/IV paediatric SCHFs treated by close reduction and percutaneous K-wire fixation were selected for this retrospective study. The demographic, clinical and radiographic parameters of all cases were collected. The lateral rotation percentage (LRP) was measured on X-rays to evaluate postoperative malrotation alignment of the fracture. All cases were categorized into 4 groups according to LRP: LRP ≤ 10% (210, 71.2%), 10% < LRP ≤ 20% (41, 13.9%), 20% < LRP ≤ 30% (26, 8.8%) and LRP > 30% (18, 6.1%). The carrying angle, ranges of multidirectional motions, Mayo Elbow Performance Score (MEPS) and Flynn’s Standard Score (FSS) of the injured elbow were assessed 6 months postoperation and compared among different groups. ROC analysis based on LRP and the excellent/good rate of FSS was performed to determine the acceptable maximum degree of postoperative malrotation alignment.ResultsThere was no difference in the demographic characteristics (age, sex, injured side and fracture type), postoperative Baumann angle, carrying angle or range of forearm rotation among the 4 groups (P > 0.05). The operation time and time from operation to K-wire removal were longer in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). The shaft condylar angle, range of elbow flexion, MEPS and FSS of the injured elbow 6 months postoperatively were lower in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). ROC analysis based on LRP and the excellent/good rate of FSS showed an area under the curve of 0.959 (95% CI 0.936–0.983), with a cutoff value of 26.5%, sensitivity of 95.3% and specificity of 90.1%.ConclusionA certain degree of residual malrotation alignment deformity of the SCHF may reduce the shaft condylar angle and extend the time from operation to removing the K-wire and affect elbow function, especially the range of elbow flexion. The acceptable maximum degree of residual malrotation deformity expressed as the LRP value was 26.5%.

Functional outcome of close reduction and internal fixation by C-C screw or Steinmann pin fixation of fracture calcaneum

Abstract Background: Fracture of calcaneum results in serious and prolonging disability. Considering the high rate of malunion and severe loss of function, it will be better to choose open reduction and internal fixation as a primary mode of treatment for calcaneum fractures. Materials and Methods: This study consists of 45 fractures of calcaneum treated by using close reduction and internal fixation and subtalar arthrodesis. Of the 45 fractures, 16 (35.56%) were treated by using the C-C screw within 2 weeks of injury and 29 (64.44%) were treated by using the percutaneous k-wire or Steinmann pin or C-C screw. Results: At the final follow-up, the mean AO foot and ankle score score of the patients was 89.28 with P value ≤ 0.0001. Conclusion: Early motion prevents stiffness of subtalar joint and ankle joint and leads to early function and psychological rehabilitation. Close reduction and internal fixation by using the C-C screw or Steinmann pin is a safe and effective method for treating displaced intra-articular fracture of calcaneum.

Radiologic, clinical, and functional evaluation of children with displaced T-condylar fractures treated by closed reduction and percutaneous fixation using the Mayo Elbow Performance Score.

T-condylar (T-C) fractures of the distal humerus are rare in children. There is no accepted treatment for such an injury, and there is a lack of reports evaluating the outcome of T-C fractures treated by closed reduction and percutaneous fixation. The aim of this study was to evaluate the feasibility of closed reduction and percutaneous K-wire and screw (CRPKS) fixation in patients with type II and III T-C fractures according to the Toniolo-Wilkins classification modified by Canavese et al. (TWC classification). The clinical data of 12 consecutive patients (8 males, 4 females) who were younger than 14 years of age and who had a T-C fracture that was managed by CRPKS were retrospectively evaluated. Fractures were classified according to the TWC classification. The baseline information of the patients, carrying angle (CA) and Mayo Elbow Performance Score (MEPS) were used to evaluate clinical and functional outcomes; related complications were recorded. Statistical analysis was performed. The mean age at the time of injury was 11.6 ± 1.8 years (range, 8-14). The time from injury to surgical treatment was 1.5 ± 1.0 days (range, 0-3), and the mean follow-up duration was 33.7 ± 12.3 months (range, 18-61). Surgery lasted 45.7 ± 7.6 min on average (range, 35-58). All fractures healed in 4.9 ± 1.0 weeks on average (range, 4-7). At the last follow-up visit, the CA was 12.6° ± 5.8° on the injured side and 13.8° ± 1.8° on the uninjured side (p=0.432). The MEPS was 100 (95, 100) on the injured side and 100 (100, 100) on the uninjured side (p=0.194). Three complications were recorded. Good functional and radiological outcomes can be expected in pediatric patients with type II and III T-C fractures treated by CRPKS. The technique is relatively simple to perform and has a lower rate of complications.

Distal End Radius Fractures Managed Surgically by Combined Antegrade and Retrograde Percutaneous K-wiring

Distal End Radius Fractures Managed Surgically by Combined Antegrade and Retrograde Percutaneous K-wiring

Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture–dislocations

PurposeAnkle fracture–dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations.MethodsA total of 67 patients with ankle fracture–dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, a 10-point visual analog scale (VAS) score (range 0–10), and complications before and after the definitive surgery were recorded.ResultsA significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036).ConclusionAnkle fracture–dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.

Clinical and Radiological outcome of Gartland Type-III closed supercondylar fracture of humerus in Children treatment by percutaneous K-wires fixation

Introduction: Supracondylar fracture of the humerus is the most common fracture of the elbow in children and displacement is common. Main problem regarding management of early supracondylar fracture are obtaining and maintaining reduction as they commonly present in the emergency department with varying degrees of soft tissue swelling. Objective: To assess the Clinical and Radiological Outcome Type III Closed Supracondylar Fracture Of Humerus in Children treatment by percutaneous K-wires fixation. Methods: This study was carried out at the NITOR, over a period of 24 months between January 2015 to December 2016. The total number of patients were 30. All patients suffering from closed supracondylar fracture of humerus in children. Each Gartland type-III closed Supracondylar Fracture of humerus among supracondylar Fracture in children attended at emergency, outpatient department and admitted in NITOR. Results: A total number of 30 patients were enrolled in this study as per inclusion and exclusion criteria. Diagnosis of the supracondylar fracture of humerus was made by history, clinical examination and radiological evidence. The youngest patient in our series is 3 years old and the oldest is 12 years. Majority were in 5-8years. Among 30 patients mean age was 6.85 years with SD = ± 2.37 years. In the present series, maximum patients were male 22 (73.3%) and 8 (26.7%) patients were female. Male female ratio 2.75:1. Male patients were predominant in this study. The results are shown in table-I. In the present series, 19 (63.3%) with left sided supracondylar fracture of humerus and 11(36.7%) presented with right sided supacondylar fracture of humerus. The results are shown in Table-II. Out of 30 cases 15 (50%) cases gave history of fall from tree, 6(20%) cases gave history of fall from bed, 4(13.3%) cases gave history of fall during playing, 5(16.7%) cases gave history of RTA due to fall from bicycle. In the present series, postero-medial fracture was found in 18(60.0%) cases and postero-lateral fracture in 12 (40.0%) cases. Out of 30 patient’s about 16 (53.3%) of the patient’s was operated between (13-18) hours of receiving injury, 11 (36.7%) with in (7-12) hours and 1 (3.3%) within (0-6) hours of injury and 2(6.7%) with in (19-24) hours of injury, mean interval between injury and Operation was 8.06 ± 5.52 hours. Out of 30 patient’s, 22 (73.3%) of the patients stayed in the hospital for 1 day and 8 (26.7%) of the patients stayed in the hospital for 2 days. The mean duration of hospital stay was 1.26 ± 0.45 days. In this series, among 30 Patients, 27(90.0%) had radiologically sufficient callus formation and 3(10.0%) patients had no sufficient callus formation. Functional outcome was satisfactory result (Excellent, Good and Fair) were 27(90.0%) and unsatisfactory result (poor) was 3 (10.0%). Conclusion: Finally, the result shows that in Gartland type-III closed supracondylar fracture of the humerus, closed reduction and stabilization by two lateral parallel percutaneous 'K'-wires is the good method for treatment.

Antegrade Flexible Nailing for Pediatric Metaphyseal-diaphyseal Junction Distal Radius Fracture, is it Safe?

Fractures involving the distal radius metaphyseal-diaphyseal junction (MDJ) present a unique challenge for pediatric orthopedic surgeons. These fractures are too proximal for percutaneous K -wire fixation and too distal for retrograde flexible nailing. The purpose of this study was to: (1) determine the safety of a described antegrade approach from the posterior interosseous nerve (PIN); (2) assess the efficacy of antegrade nailing in cases of distal MDJ fractures; and (3) describe a standardized lateral approach to the proximal radius. A cadaveric study was performed using 10 adult forearms. Anterograde flexinail was introduced at the proximal radius based on the described "safe zone". Distal MDJ fractures were created using osteotomes. We evaluated the distance between the entry point to the PIN in addition to the quality of the reduction for the fracture. The average distance between the entry point and piercing instrument to the PIN was 5.4 cm (range: 4.7 to 6.0 cm). When grouped based on sex, the average distance was significantly further for males (5.8 cm, range: 5.2 to 6.0 cm) versus females (4.9 cm, range: 4.7 to 5.2 cm), P =0.004. Fracture reduction was not maintained after the introduction of the antegrade flexible nail across the fracture site. For all specimens, >25% displacement was seen on the anterior-posterior imaging. Our modified lateral approach to the starting point in the proximal radius is safe as long as the entry point for antegrade flexible nailing stays proximal to the radial tuberosity during the lateral approach to the proximal radius while the elbow is flexed and the forearm pronated.

Assessment of Functional Outcome of Distal Radius Fracture Treated with Kirschner’s Wire

Introduction: Distal radial fractures are most common fracture which accounts 8-15 % of all bony injuries. There is a wide variety of treatment options and selection mainly depends on age, occupation, type of fracture. Fracture realignment is most important element for good functional outcome. Closed reduction and percutaneous k-wire fixation is most convenient method as it is cost effective.&#x0D; Aims: To evaluate the functional outcome of distal radial fractures treated with closed reduction and percutaneous pinning.&#x0D; Methods:This prospective observational study was conducted in Nepalgunj medical college Teaching hospital, Kohalpur from September 2021 to August 2022. Patient aged above 18 and below 70 years who had isolated distal radius fracture with k wire fixation. Functional results were assessed at a follow up of 6 months, by modified Gartland and Werley scoring system.&#x0D; Results: In this study out of 45 cases there were male preponderance 29 (65%). The mean age of our patient was 36.8 (SD±12.80) years. K-wires were removed between four to six weeks of operation depending upon the union and followed for six months. On final follow up variables assessed according to Modified Gartland and Werley scoring system which shows, 25 patients had excellent (51.11%) and 13 good (33.33%) functional outcome. Overall, 84.44% of the patients achieved an excellent to good functional outcome. Still residual pain and dorsal angulation were complications post-operatively and was in acceptable limits in majority of cases.&#x0D; Conclusion: Closed reduction and percutaneous pinning for distal radius fractures have shown to achieve good functional outcome. Most of the complications after the procedure were within the acceptable limits. Further studies are required to assess its efficacy in various other fracture types.

Comparison of Modified K-wire Fixation with Open Reduction and Internal Fixation (ORIF) for Unstable Colles Fracture in Elderly Patients.

Open reduction and internal fixation (ORIF) is the standard treatment of unstable Colles fracture among the elderly. Modified percutaneous K-wire fixation is becoming increasingly popular in recent years. However, there is controversy concerning its appropriate use. This study aimed to compare the early safety and efficacy of the two different treatments and provide an alternative method for the treatment of unstable Colles fracture among the older population. Electronic medical records of 60 consecutive unstable Colles fractures patients who underwent surgery from June 2019 to October 2021, by modified percutaneous K-wire fixation (30 patients) or ORIF (30 patients), were reviewed retrospectively. All cases were followed up for 3 months. The outcomes of patients were assessed with operation time, intraoperative blood loss, visual analog score (VAS) for wrist joint pain, palmar tilt (PT), radial inclination (RI), radial height (RH), Gartland-Werley score, total hospitalization costs, hospital stays, postoperative complications, and patient subjective satisfaction. General patient information was also collected. Independent Student's t-test or Mann-Whitney U test were used to compare continuous data. Pearson's chi-square test or Fisher's exact test were used to analyze the categorical data. The operation time and intraoperative blood loss were significantly shorter in the K-wire group than in the ORIF group (p < 0.05). Compared with the ORIF group, the VAS of the K-wire group was significantly lower at 1 and 3 days postoperatively (p < 0.05), and no significant differences were observed in VAS between the two groups preoperatively and 7 days postoperatively (p > 0.05). There were no significant differences in the PT, RI, and RH between the two groups preoperatively and at 1, 4, and 8 weeks postoperatively (p > 0.05). Patients in the K-wire group had significantly shorter hospital stays and lower total hospital costs (p < 0.05). All patients were followed up for 3 months, and there was no significant difference in the Gartland-Werley score between the two groups (p > 0.05). Compared with the ORIF group, postoperative complications were lower, and patient subjective satisfaction was higher in the K-wire group, but there were no significant differences (p > 0.05). Modified percutaneous K-wire fixation in the treatment of unstable Colles fracture among the elderly is a safe, effective, rapid, and minimally invasive surgical option for surgeons.

Early complications of percutaneous K-wire fixation in pediatric distal radius fractures—a prospective cohort study

IntroductionDistal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures.Materials and methodsOne hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien–Dindo–Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites.ResultsForty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery—deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common—40 wrists (33,6%).ConclusionsThe CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient’s postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.

Transepiphyseal percutaneous intramedullary Kirschner wire (TEPIK) in diametaphyseal radius fractures (DMRF) – experiences in 59 children

BackgroundDistal forearm fractures are widespread in children and adolescents. The radial transition zone between diaphysis and metaphysis is not universally defined. Still, diametaphyseal radius fractures (DMRF) are prone to complications, and a commonly agreed standard for their treatment has yet to be established. MethodsWe report on 59 children with unstable DMRF treated with a transepiphyseal, percutaneous, intramedullary K-wire (TEPIK) from 2010 to 2020. After fracture reduction, the patient's hand is held in palmar flexion. Next, a 1.8-2mm K-wire is inserted just beyond Lister's tubercle through the epiphysis and advanced, crossing the physis straight into the medullary cavity of the diaphysis. We report radiographic geometry before and after the treatment, operation times, course of treatment, functional results, and complications. ResultsWe saw no loss of reduction and no remaining functional deficits. Surgical trainees performed this technique in 71.2%. The mean operating time was 29 minutes. Percutaneous K-wires could be removed without anesthesia or sedation in our outpatient clinic in 81.4%. We saw two refractures after a second high-energy trauma and seven K-wires that migrated subcutaneously because they were cut too short. ConclusionTEPIK is a quick and easy treatment for unstable DMRF. It provides safe management with a single, definite surgery if metal removal of an ulnar ESIN is unnecessary. This study is one of the most extensive series on the surgical treatment of DMRF reported in the literature and presents successful results of TEPIK in the treatment of unstable DMRF.

Study of outcome of displaced calcaneal fractures by closed reduction and percutaneous internal fixation with multiple k wires and screws

Background: Calcaneum is the largest of the tarsal bones and the largest bone of the foot. Calcaneum fracture account for 2% of all fracture of the body and 60% of all tarsal fractures. Many calcaneal fractures are work related as they result from a fall from height, especially in male age 35-45 years. In our study we treated the displaced calcaneal fracture with closed reduction and percutaneous fixation using multiple percutaneous K-wires and screw to evaluate their functional outcome. Methods: The study was conducted as a prospective study at the department of Orthopaedics, Dr. Shankarrao chavan Government Medical College, Nanded, India during the period January 2019 to June 2020. Thirty patients of 20 to 60 years, who underwent surgical fixation for displaced calcaneal fracture using multiple K wires and screws were followed up. Functional outcomes at six month follow up were assessed. Results: In this study we selected 30 patients with displaced calcaneal fracture admitting in our institute. All patients underwent operative procedure in the form of multiple k wire and cc .screws by percutaneous approach Out of all 30 patients treated with this method had shown excellent results with minimal postoperative complications. Conclusions: The study with percutaneous K wires and screws for displaced calcaneal fractures showed very good functional outcome. Although it was not free of complications, our study has shown very good results. Technique involve in our study is less invasive, with minimum blood loss, less operative time without soft tissue stripping.