Percutaneous Kirschner Wire Fixation Research Articles

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

Reconstruction of medial and lateral column periosteal hinge using Kirschner wire to assist in closed reduction of multi-directional unstable humeral supracondylar fractures in children

To investigate the effectiveness of medial and lateral column periosteal hinge reconstruction using Kirschner wire in the closed reduction of multi-directional unstable humeral supracondylar fractures in children. A clinical data of 43 children with multi-direction unstable humeral supracondylar fractures, who met the selection criteria and were admitted between August 2020 and August 2022, was retrospectively analyzed. Twenty-one cases of fractures were treated wuth closed reduction after medial and lateral column periosteal hinge reconstruction using Kirschner wire and percutaneous Kirschner wires fixation (study group), while 22 cases of fractures were treated by traditional closed reduction technique and percutaneous Kirschner wire fixation (control group). There was no significant difference in gender, age, cause of injury, fracture side, and interval from injury to operation between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, the number of children who were changed to open reduction after closed reduction failure, fracture healing time, complications within 2 months after operation, and the Flynn score of elbow joint function at last follow-up were compared between the two groups. All the fractures in the study group were successfully closed reduction, and 4 cases in the control group were changed to open reduction and completed the operation, the difference between the two groups was significant ( P=0.040). The operation time and intraoperative fluoroscopy times of the study group were significantly less than those of the control group ( P<0.05). All children in both groups were followed up 6-18 months with an average of 9.0 months in the study group and 9.8 months in the control group. Imaging review showed that the fractures of both groups healed, and the difference in the healing time between the two groups was not significant ( P=0.373). According to Flynn score at last follow-up, the excellent and good rate of elbow joint function was 95.2% (20/21) in the study group and 86.4% (19/22) in the control group, with no significant difference ( P=0.317). There was no complication such as infection or irritation at the end of Kirchner wire within 2 months after operation. For children with multi-directional unstable humeral supracondylar fractures, the use of Kirschner wires to reconstruct the medial and lateral column periosteal hinge to assist in closed reduction has the advantages of shortening operation time, reducing intraoperative fluoroscopy times, and effectively reducing the incidence of open reduction, and can achieve similar postoperative elbow joint function when compared with traditional closed reduction technique.

Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing.

This retrospective study compared two minimally invasive surgical methods for fifth metacarpal neck fractures in adolescents: percutaneous Kirschner wire (K-wire) fixation and elastic stable intramedullary nailing (ESIN). This study involved 42 adolescents aged 11 to 16 years with fifth metacarpal neck fractures treated by either K-wire fixation (n = 20) or ESIN (n = 22). The palmar tilt angle and shortening were compared on radiographs preoperatively and 6 months postoperatively. Total active range of motion (TAM), the visual analogue scale score for pain, and the Disabilities of the Arm, Shoulder and Hand score for upper limb function were recorded at 5 weeks, 3 months, and 6 months postoperatively. The mean TAM was significantly greater in the ESIN than K-wire group at all postoperative time points. The mean external fixation time was 2 weeks longer in the K-wire than ESIN group. One patient in the K-wire group developed infection. There was no statistically significant difference between the two groups in other postoperative outcomes. ESIN fixation has the advantages of greater stability, better activity, a shorter external fixation time, and a lower infection rate than K-wire fixation in the treatment of fifth metacarpal neck fractures in adolescents.

Comparison between Volar Locking Plate and Kirschner Wire Fixation for Unstable Distal Radius Fracture: A Meta-Analysis of Randomized Controlled Trials

Abstract Objective This study aims to compare the outcomes of volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of unstable distal radius fractures. Methods We systematically searched multiple databases, including MEDLINE, EMBASE, Cochrane Central till January 2022 for randomized controlled trials (RCTs) that met eligibility criteria. Following outcomes were evaluated at 6-week, 3-, 6-, and 12-month follow-up period: Disabilities of the Arm, Shoulder, and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) score, grip strength, range of motion, and complication incidence. Meta-analysis was performed using random effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval. Results Fourteen RCTs with 1,450 participants met the inclusion criteria. DASH scores were significantly better for VLP fixation at 6th week (MD = 19.02; p &lt; 0.001), 3rd (MD = 10.79; p &lt; 0.001), 6th (MD= 7.78; p &lt; 0.001), and 12th month (MD = 2.94; p &lt; 0.001) postoperation. At 3-month follow-up period, VLP treatment exhibited better grip strength (MD = − 10.32; p &lt; 0.001) and PRWE scores (MD = 8.78; p &lt; 0.001). There was a statistically significant early advantage in flexion, extension, pronation, supination, radial deviation, and ulnar deviation in the VLP group at 6-week follow-up, but at 1-year follow-up only significantly better extension was observed. At 1 year, radiographic outcomes were similar except for volar tilt favoring VLP fixation (p &lt; 0.001). Superficial infections were more common in patients treated with K-wire (RR = 2.89; p = 0.001), but there was no difference in total complications or reoperation rates (p &gt; 0.05). Conclusion This meta-analysis suggests that VLP fixation and K-wire fixation are both effective procedures, but existing literature does not provide sufficient evidence to demonstrate the superiority of either method. Although VLP fixation improves DASH score, extension and volar tilt at 12-month follow-up, the difference is small and unlikely to be noticeable to the patients.

Patient Reported Outcome Measures (PROMs) in Surgery: Evaluation after Minimally Invasive Reduction and Percutaneous K-Wires Fixation for Intra-Articular Calcaneal Fractures

The optimal surgical treatment of intra-articular calcaneal fractures (IACF) is still under debate. In the literature, results are based on clinical or radiographical findings. Few studies have evaluated the effect of patient expectations on patient-reported outcomes after surgery and little is known about outcomes directly reported by the patient who experienced it. Patient reported outcome measures (PROMs) may represent a viable and useful tool for evaluating the efficacy of the procedure and can be considered as an indicators of health-care quality. The aim of this study is to evaluate PROMs after minimally invasive reduction and percutaneous Kirschner-wires fixation for IACF, and to compare PROMs to pre-operative and last follow-up radiographic findings. 33 consecutive patients with IACF treated with minimally invasive reduction and percutaneous K-wires fixation were included. Data collection included demographics, pre-operative and last available Böhler and Gissane angle X-rays, foot function index (FFI), and foot and ankle outcome score (FAOS). At a mean follow up of 36.7 months, the mean FFI score was 24.3 ± 19.9 and the mean FAOS score was 68 ± 24.8. Patients with better Gissane angle showed better activity limitations FFI subscores. Moreover, worse pre-operative Gissane and Böhler angle were significantly associated with a worse total FAOS score and subscores. Minimally invasive reduction and percutaneous K-wires fixation provided satisfactory PROMs. Despite these results, prospective randomized studies are required to confirm the validity and reliability of PROMs in evaluating different treatments.

VOLAR LOCKING PLATE FIXATION VERSUS PERCUTANEOUS KIRSCHNER WIRE FIXATION FOR DISTAL RADIAL FRACTURES IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

This study aims to compare the outcomes of Volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of distal radius fractures.We systematically searched multiple databases, including MEDLINE for randomized controlled trials (RCTs) comparing outcomes of VLP fixation and K-wire for treatment of distal radius fracture in adults. The methodological quality of each study was assessed by the Cochrane Risk of Bias tool. Patient-reported outcomes, functional outcomes, and complications at 1 year follow up were evaluated. Meta-analysis was performed using random-effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval (CI).13 RCTs with 1336 participants met the inclusion criteria. Disabilities of the Arm, Shoulder and Hand (DASH) scores were significantly better for VLP fixation (MD= 2.15; 95% CI, 0.56-3.74; P = 0.01; I2=23%). No significant difference between the two procedures for grip strength measured in kilograms (MD= −3.84; 95% CI,-8.42-0.74; P = 0.10; I2=52%) and Patient-Rated Wrist Evaluation (PRWE) scores (MD= −0.06; 95% CI,-0.87-0.75; P = 0.89; I2=0%). K-wire treatment yielded significantly improved extension (MD= −4.30; P=0.04) but with no differences in flexion, pronation, supination, and radial deviation (P &gt;0.05). The risk of complications and rate of reoperation were similar for the two procedures (P &gt;0.05).This meta-analysis suggests that VLP fixation improves DASH score at 12 months follow up, however, the difference is small and unlikely to be clinically important. Existing literature does not provide sufficient evidence to demonstrate the superiority of either VLP or K-wire treatment in terms of patient-reported outcomes, functional outcomes, and complications.

Transphyseal distal humeral separation in neonates: A case series

IntroductionBirth trauma is a rare condition. Typically, injury in neonates occurs as a result of obstetrical manipulation to allow delivery or from trauma sustained during a difficult passage through the birth canal. Transphyseal separation of the humerus is particularly rare. Diagnosis is not always straightforward and is prone to mistakes. There is a general consensus that the outcome is usually favorable. It is generally agreed that the fracture needs to be realigned, while the suggested methods in contention vary from a simple plaster cast to closed and even open reduction and percutaneous Kirschner wire fixation. The purpose of this study was to review our experience in treating transphyseal distal humeral separation in neonates to better define the diagnostic and therapeutic pathway. MethodsTen consecutive cases of transphyseal distal humeral separation in neonates were treated at our institution between September 2008 and June 2021. All cases were reviewed and clinical data collected on birth injury risk factors, diagnostic workup, age at diagnosis and treatment, and type of treatment. Results of treatment and outcome were analyzed for time to fracture union, complications and clinical alignment, range of motion and residual pain at the latest follow-up. ResultsMean age at diagnosis was 4.2 days (range 0 to 9 days) and time between diagnosis and treatment varied from three to 26 h (average 15 h). Risk factors for birth injury were present in six patients. Four patients were initially treated with closed reduction and cast immobilization, all the other cases were treated with closed reduction and percutaneous pinning. Arthrography was performed at the time of treatment in six cases. Average follow-up was 37 months (range 12 to 120 months). At the latest follow-up, all fractures had healed with full range of motion. No clinical or radiographic deformity requiring repeated surgery or physeal damage was observed. ConclusionsThis rare lesion may occur both in the presence and in the absence of risk factors. Due to the rarity of the injury, misdiagnosis and delayed diagnosis are not uncommon. Treatment with closed reduction and percutaneous pin fixation is advisable and safe.

A rare case of an isolated traumatic cuboid dislocation treated with a novel technique

Complete cuboid dislocation without cuboid fracture are rare injuries and there is a paucity of literature describing their management. Previous studies have reported on the use of closed reduction casting, internal fixation, and Kirschner wire fixation in the treatment of such injuries. This case report presents the successful management of a complete cuboid dislocation in a healthy 42-year-old man following a motorcycle accident. The dislocation was reduced and stabilized using a novel mini-open approach that involved distraction of the lateral column complex through the use of an external fixator, followed by percutaneous Kirschner wire fixation to reinforce the area. The patient was monitored for 46 months and continues to function without limitation. This case report highlights the successful application of a novel fixation construct using an external fixator device and percutaneous Kirschner wire fixation for the treatment of a complete cuboid dislocation without cuboid fracture. The technique presented in this report could offer a valuable additional option for physicians treating patients with these rare injuries.

A novel approach for the treatment of Jacob II and III fractures of the lateral humeral condyle in children: Percutaneous Kirschner wire fixation with ultrasound localization.

This research investigated the effectiveness of percutaneous Kirschner wire fixation in children with Jacob II and III lateral humeral condyle fractures. 28 children with Jacob II and III lateral humeral condyle fractures were treated with percutaneous Kirschner wire fixation under ultrasound localization, followed by cast immobilization for 4-5 weeks at our institution from January 2018 to April 2022. X-rays were evaluated on the first postoperative day to assess fracture reduction and Kirschner wire fixation. After 2 and 4 weeks, x-rays were taken to assess fracture healing and the presence of discomfort and infection was evaluated. After confirming fracture healing and callus formation, the cast and Kirschner wire were removed. Rehabilitation exercises were conducted following removal to restore elbow function. At the last follow-up, most results were excellent (n = 25) and good (n = 3) according to Flynn's criteria. Moreover, according to the Mayo Elbow Functional Score Scale (MEPS), all 28 children had excellent scores, with no significant difference in MEPS scores between the lesion and healthy sides (t = 1.533, p > 0.05). The present study substantiated that our novel approach is more convenient and effective, brings less trauma and complications and no radiation and deserves clinical promotion.

EVALUATION OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES TREATED WITH CRISSCROSS VS LATERAL PINNING

Introduction : Supracondylar humerus fractures are the most common elbow fractures seen in children. The peak age is 5 to 6 years .Gartland classified these fractures in to extension and flexion type with former being most common. Extension injuries are further divided in to un displaced (type 1),partially displaced with intact posterior cortex(type 2),completely displaced (type 3).Type 2 and type 3 fractures requires intervention (closed reduction and pinning). In this scenario, our study is designed to know the functional outcome of Criss cross pinning versus lateral pinning in supracondylar humerus fractures Aim : 1. To restore the anatomy of the distal end of the humerus with percutaneous Kirschner's wire fixation. 2. To evaluate the functional and cosmetic outcome of displaced supracondylar fractures of the humerus in children treated with cross pinning and lateral pinning. Materials And Methods : A prospective study with 30 cases of Gartland type 2 and type 3 supracondylar fracture humerus, treated by lateral ( n=16 ) and criss cross ( n=14 ) pinning, was conducted between October 2018 to october 2020. The results were expressed as mean and standard deviation and p&lt;0.05 was considered as statistically significant. Results : In this study, among thirty patients, cross pinning was done in fourteen patients (46.67%), and lateral pinning was done in sixteen patients (53.33%). All patients had satisfactory results according to Flynn's criteria.Conclusion : There was no significant difference in cosmetic outcome, i.e. loss of carrying angle, and in functional outcome i.e.; loss of flexion in degrees between crisscross Kirschner wire fixation and lateral Kirschner wire fixation in supracondylar fractures of the humerus in children.

Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children-A Retrospective Study.

Supracondylar humerus fractures (ScHF) account for 60% of fractures of the elbow region in children. We assessed the relationship between neurovascular complications and the degree of fracture displacement as rated on the basis of modified Gartland classification. Moreover, we aimed to evaluate predisposing factors, e.g., age and gender, and outcomes of neurovascular complications in ScHF. Between 2004 and 2019, we treated 329 patients with ScHF at the Department of Traumatology and Orthopedics of the Upper Silesian Child Centre, Katowice, Poland. Mean age of patients (189 boys and 140 girls) was 7.2 years (Confidence interval: 6.89, 7.45). Undisplaced fractures were treated conservatively with a cast. Displaced fractures were managed by closed reduction and percutaneous Kirschner wire fixation using two pins inserted laterally. We retrospectively assessed the number of neurovascular lesions at baseline and recorded any iatrogenic injury resulting from the surgical intervention. Acute neurovascular lesions occurred in 44 of 329 ScHF patients (13.4%). The incidence of accompanying neurovascular injuries was positively associated with the severity of fracture displacement characterized by Gartland score. Vascular injuries occurred mainly in Gartland type IV ScHF, while nerve lesions occurred in both Gartland type III and IV ScHF. We noted a significantly higher mean Gartland score and mean age at injury in the group of children suffering from neurovascular injuries when compared to those in the group without such injuries (p = 0.045 and p = 0.04, respectively). We observed no secondary nerve lesions after surgical treatment. For the treatment of ScHF in children, we recommend closed reduction and stabilization of displaced fractures with K-wires inserted percutaneously from the lateral aspect of the upper arm. We advocate vessel exploration in case of absent distal pulses after closed reduction but do not consider primary nerve exploration necessary, unless a complete primary sensomotoric nerve lesion is present.

Fractures of the Distal Radial Metaphysis in Children: Which Ones Need Reduction?: Commentary on an article by Topi Laaksonen, MD, et al.: "Epidemiology, Treatment, and Treatment Quality of Overriding Distal Metaphyseal Radial Fractures in Children and Adolescents".

Commentary Overriding fractures of the distal radial metaphysis in children are common and are of interest to many orthopaedic surgeons. The large study by Laaksonen et al. is population-based and has important data regarding the epidemiology and outcomes of treatment of overriding distal radial fractures. Closed manipulation in the emergency department was associated with a 46% failure rate and a high utilization of opioid analgesics. Fractures treated with use of cast immobilization in an overriding position showed excellent functional outcomes and a low rate of secondary interventions. In the 1955 textbook “Fractures in Children,” Blount described the principles of fracture remodeling in children and advocated for nonoperative treatment of distal radial and ulnar fractures1. Since that time, techniques and technology have evolved, and the availability of fluoroscopy, percutaneous Kirschner wire fixation, and flexible intramedullary nailing have allowed the development of better techniques than were available when that book was written. These new techniques and technologies permit accurate reduction, stable fixation, and early mobilization. Blount understood the process of remodeling of pediatric fractures better than many of his contemporaries and perhaps better than many of the current generation of orthopaedic surgeons. Blount’s principles of fracture remodeling are as follows: 1. Remodeling occurs more quickly the closer the fracture is to the physis. 2. Remodeling occurs more quickly and extensively when residual displacement is in the plane of motion of the adjacent joint. 3. The speed of remodeling is related to the age at the time of the injury, with younger children experiencing faster remodeling1. These 3 principles are relevant to the treatment of distal radial fractures in growing children. Most fractures occur within 2 centimeters of the physis, as described in the study by Laaksonen et al. The most frequent direction of displacement is dorsal, and this is the primary plane of motion of the wrist joint1. Most fractures occur in active growing children1. Therefore, according to the teachings of Blount, these fractures should remodel quickly, and in younger children, they should remodel fully1. However, of the extensive references utilized by Laaksonen et al. to support their study, only Crawford et al. supported the use of immobilization in a below-the-elbow cast rather than reduction and fixation as the primary treatment2. Three randomized controlled trials examined the benefits of adding percutaneous Kirschner wire fixation after closed reduction versus cast immobilization, yet none of these studies addressed the central question of whether such fractures should be reduced3-5. Several of the referenced studies assessed the outcomes of reduction and Kirschner wire fixation compared with immobilization following loss of position of a previously reduced fracture. The evidence, although of low quality and inconclusive, suggested that most of these fractures do very well following simple alignment in a below-the-elbow cast without reduction and without fixation1,2. In the current era, when anatomic reduction and stable fixation of fractures is the prevailing philosophy for the majority of osseous injuries, it can be difficult for attending surgeons, residents, and parents to understand that nature may be capable of doing as good a job as technology. The educated parent of today, with “Dr. Google” in hand, will want to see their child’s radiographs and may be horrified by advice to accept a displaced fracture with obvious shortening1,2. A recently published book has a treasure trove of images to reassure the anxious parent and help convince doubting residents that surgery is not always better than nature6. This book is the 2021 update to the classic textbook by Blount and is an invaluable resource for counseling parents and teaching residents1,6. The current evidence for management is inconclusive, which is unsatisfactory given that this is a common fracture with substantial associated treatment costs2. The uncertainty regarding management has been acknowledged internationally in the British Society for Children’s Orthopaedic Surgery Research Priorities and in a survey of members of the Pediatric Orthopaedic Society of North America. Additionally, a multicenter randomized controlled trial, the Children’s Radius Acute Fracture Fixation Trial (CRAFFT), has been commenced in the United Kingdom to address the question of whether outcomes following closed reduction are better than those following simple immobilization. Given that there is equipoise regarding treatment and a lack of high-quality evidence, such studies are the only way to improve the evidence base. As a surgeon who has utilized Blount’s principles of remodeling for more than 40 years, I have had the opportunity to observe excellent outcomes from nonoperative treatment of this and other pediatric fractures. However, this is anecdote, not evidence. I look forward to the outcomes of the CRAFFT Trial. My hunch is that Blount was correct and that we do not need to reduce or internally fix these fractures in younger children1,2,7.

The Concentration of Selected Inflammatory Cytokines (IL-6, IL-8, CXCL5, IL-33) and Damage-Associated Molecular Patterns (HMGB-1, HSP-70) Released in an Early Response to Distal Forearm Fracture and the Performed Closed Reduction With Kirschner Wire Fixation in Children.

The evaluation of trauma after surgery through objective analysis of biochemical markers can help in selecting the most appropriate therapy. Thus the aim of the study was the evaluation of the concentration of selected inflammatory cytokines (IL-6, IL-8, CXCL5, IL-33), C-reactive protein (CRP), and damaged-associated molecular patterns (DAMPs): HMGB-1, HSP-70 in the plasma of children in response to bone fracture and 12-14 hours after subsequent surgery performed by closed reduction with percutaneous Kirschner wire fixation (CRKF). The study will answer the question if the CRFK procedure leads to excessive production of inflammatory and damage markers. Blood samples from 29 children with distal forearm fractures were collected 30 min. before CRKF procedure and 12-14 hours after performance of the procedure. The control group was composed of 17 healthy children. IL-6 and CRP concentrations were analyzed using routinely performed in vitro diagnostics tests; the remaining proteins were analyzed with the use of the ELISA method. Increased values of IL-6, CRP, and HSP-70 represented an early inflammatory response to distal forearm fractures classified as SH-II type according to the Salter-Harris classification system. However, the median CRP concentration was within the reference values not indicative of inflammation. The CRKF procedure may be a good solution for the treatment of bone fractures, as damaged associated molecular patterns – HMGB-1 and HSP-70 – did not significantly differ 12-14 hours after the approach was applied as compared to the control group. Moreover, the increase in IL-6 concentration after the CRKF procedure was 1.5-fold to the level before CRKF, while the increase of this marker in response to the distal forearm fracture was 4.3-fold compared to the control group. Based on this data, it appears reasonable to suggest that the CRKF approach caused less damage and inflammatory response in comparison to the response to the fracture itself.

Comparison between two methods of fixation of Second and Third Metacarpal shaft Fractures: A Meta-analysis

ABSTRACT:Background: Metacarpal bone fractures considered one of the common skeletal fractures, accounting for 36% of all hand and wrist fractures.Patients and Methods: Only clinical studies of both methods used in the management of closed fractures of the second and third metacarpals were included in this review. It also included studies comparing open reduction and int. fixation with plate and screws Vs. percutaneous crossed K -wire fixation for metacarpal fractures. The Ten papers included in the systematic review and meta – analysis were retrospective cohort studies published between 2003 and 2019. The aim of this study is to evaluate the final results and postoperative complications for two methods of fixation within the treatment of fractures of Second and Third metacarpal bones: fixation with plate and screws Vs. percutaneous crossed K -wire.Results: No specifications used for the pattern of fracture, except for the fractures involving shaft of the second and the third metacarpals. All fractures needed to be operated due to deformity, angulations or rotation. No correlation could be done between types of fracture (i.e., spiral, oblique) and functional outcome. As all studies disscused the same indication for intervention, and on the other side, a correlation between type of fixation and functional outcome could be done.Conclusion: No recommendation made that one fixation technique is superior to another, and the complications associated with ORIF or k -wire fixation in the management of metacarpal fractures are distinct.Key words: Open Reduction - Internal Fixation - Percutaneous Kirschner Wires Fixation- fracture 2nd and 3rd metacarpalsFinancial disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.

Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal humeral fracture is 3rd most common fracture in elderly population. Selection of appropriate implant is always challenging to get optimum results in these osteoporotic bones. Though locking plates are gold standard, major complications range from 9% to 36%. To study clinical and radiological outcome of J nail technique for Neer’s three or four part proximal humeral fractures in patients more than 60 years age.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, &amp;gt;60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip Lambrinudi wires. At final follow-up, clinical outcome was assessed using constant score and radiological evaluation was done according to the Bahr criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean constant score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up to 2 years.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections.&lt;/p&gt;

Efficacy of Antibiotics in Supracondylar Fractures.

Controversy exists surrounding antibiotic use in the setting of pediatric supracondylar humerus fractures treated with closed reduction and percutaneous Kirschner wire (K-wire) fixation. While the reported incidence of infection in the literature is low, surgeons frequently administer preoperative antibiotics. The purpose of this study was to retrospectively review preoperative antibiotic use and incidence of infection in children with supracondylar humerus fractures treated with closed reduction and K-wire fixation. It was hypothesized that antibiotic administration will not affect the incidence of infection following this procedure. We performed a retrospective review of 1053 patients with supracondylar humerus fractures treated with closed reduction and K-wire fixation at 3 institutions between 2006 and 2016. Patient demographics, antibiotic administration and follow-up data were reviewed in 905 patients. Of 905 patients, 755 patients received preoperative antibiotics and 150 patients did not. The incidence of infection was 2.5% (n=22) in the group that received preoperative antibiotics and 2.0% in the group that did not receive antibiotics with an overall incidence of infection of 2.4%. The difference between groups did not reach significance (P>0.5). The majority of infections were treated with oral antibiotics with or without early pin removal. Four patients, all in the preoperative antibiotic group, required surgical debridement and intravenous antibiotics. Retrospective review of the incidence of infection in closed reduction and percutaneous pinning of supracondylar humerus fractures found no difference between patients who received preoperative antibiotics and those who did not receive preoperative antibiotics. Level III-therapeutic.

Hypodermic needle to guide Kirschner-wire placement in paediatric supracondylar humerus fractures: a technical trick.

PurposeSupracondylar humerus fractures are among the most common injuries in the paediatric population, accounting for 16% of all paediatric fractures and roughly 60% to 70% of all paediatric elbow fractures. Typical treatment for displaced and unstable supracondylar humerus fractures is surgical intervention, often with percutaneous Kirschner-wire (K-wire) fixation. Timing of surgery is dependent on the patient’s neurovascular status on presentation, with surgical emergencies being performed at all hours of day and night. Percutaneous fixation of paediatric elbow fractures can be challenging as a result of the propensity for the elbow to become quite swollen with these fractures, particularly in smaller and physiologically more immature elbows.MethodsWe have developed a simple operative technique to guide placement of percutaneous wires for supracondylar humerus fractures using a hypodermic needle as a reference marker.ResultsIn our experience, trainees utilizing this technique demonstrate greater appreciation for start point and trajectory of wires during percutaneous pinning, with better communication amongst surgical team members about necessary adjustment for optimal placement of K-wires.ConclusionUtilization of this technique has the potential to refine surgical technique by minimizing errant wire passes, radiation and operative time when performing percutaneous pinning of reduced type III supracondylar humerus fractures.Level of EvidenceV, Novel Surgical Technique

Closed Reduction and Percutaneous Pinning for Treatment of Proximal Interphalangeal Joint Pilon Fractures.

Proximal interphalangeal (PIP) joint pilon fractures are among the challenging hand injuries, which are often associated with a wide range of complications. This study aimed to report the clinical and radiological outcomes of closed reduction and percutaneous Kirschner wire (KW) insertion with or without bone cement application (for the fabrication of an external fixator) in the treatment of PIP joint pilon fractures. Twenty pilon fractures underwent closed reduction and percutaneous KW fixation through a modified technique. At the end of the follow-up period, 3 questionnaires-Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Visual Analogue Scale for pain, and Patient-Rated Wrist Evaluation-were completed. The radiological outcome was assessed by radiography. Range of motion, and grip and pinch strength were measured. The mean follow-up period was 14.57 ± 4.03 months (range, 12-20 months). The mean range of motion of PIP at the end of the follow-up period was 89.64° ± 10.82° (range, 65°-100°). The mean difference in the range of motion in the contralateral side was 21.4° ± 13°. The mean of the Quick DASH score was 13.50 ± 2.92 (range, 11-21). Two patients had residual articular malalignment, and 3 patients had angular or rotational malunion. By treating pilon fractures with the proposed technique, we achieved a satisfactory outcome. The acceptable articular and axial alignment was achieved in 75% of patients, and complications were low. The flexibility of percutaneous KW insertion and handmade external fixators makes these approaches convenient for treating PIP joint pilon fractures.

Prying reduction with mosquito forceps versus limited open reduction for irreducible distal radius\u2010ulna fractures in older children: a retrospective study

BackgroundThere are disputes about which reduction technique should be adopted in treatment of distal radius-ulna fractures in older children who failed to achieve manual reduction. This study compared clinical effects between prying reduction with mosquito forceps (PRMF) and limited open reduction (LOR) of treating irreducible distal radius-ulna fractures in older children.MethodsOne hundred ten children with irreducible distal radius-ulna fractures were selected from January 2015 to December 2017 in Xi’an Hong Hui hospital. Retrospective analysis was performed. According to different reduction techniques, these children were divided into PRMF group (59 cases) and LOR group (51 cases). All children were treated with percutaneous Kirschner wire fixation and external fixation with plaster. Operation indexes, complications and wrist joint functions were compared between the two groups.ResultsOperation time of PRMF group was shorter than that of LOR group (P < 0.05). Incision length in PRMF group was less than that in LOR group (P < 0.05). Bleeding volume of PRMF group was less than that of LOR group (P < 0.05). Incidence of complications in PRMF group was lower than that in LOR group.ConclusionsCompared with limited open reduction, it has better clinical effects of prying reduction with mosquito forceps in treatment of irreducible distal radius-ulna fractures in older children. This technique has the advantages of simple operation, less trauma, less bleeding and fewer complications, which is worthy of clinical promotion.

Management of Open Calcaneal Fractures with Medial Wounds by One-Stage Sequential Reduction and Frame Structure Fixation Using Percutaneous Kirschner Wires.

ObjectiveTo assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one‐stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires.MethodsA total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type‐II and seven type‐IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type‐II fractures, seven type‐III fractures, and three type‐IV fractures. All patients accepted one‐stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum‐assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications.ResultsThe follow‐up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (−7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P < 0.05), respectively. Three cases of superficial infection and two cases of wound dehiscence were observed in our study, which were then successfully treated with wound debridement, VAC replacement, appropriate use of antibiotics, and delayed closure. The last follow‐up revealed three cases of lateral wall expansion and six cases of mild‐to‐moderate subtalar arthritis based on the Paley and Hall scoring system. According to the AOFAS ankle and hindfoot score, one case showed excellent results, 14 cases exhibited good results, and four cases displayed fair results, with the mean of 80.7 ± 6.7 points (range, 70–90). The Maryland Foot Score revealed one case of excellent outcomes, nine cases of good outcomes, and nine cases of fair outcomes with an average of 76.8 ± 8.6 points (range, 62–90). The mean VAS for pain was 1.8 ± 1.5 (range, 0–5), and a total of 14 patients complained of mild‐to‐moderate pain when walking for a more extended period. Severe complications, such as deep infection, osteomyelitis, and soft tissue necrosis, were not observed during follow‐up.ConclusionsCollectively, one‐stage management allowed the direct restoration of calcaneal morphology with a minimal invasion of soft tissues in most open calcaneal fractures with medial wounds, and the functional outcomes were comparable to previous data.