Percutaneous Kirschner Wire Fixation Research Articles

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.

Outcome of percutaneous kirschner wire fixation for supracondylar fractures of humerus in elderly comorbid patients

Background: Management of supracondylar fractures in young adults has evolved over the last two decades but management of these fractures in elderly comorbid patients is still matter of debate. In this study we present the outcome of supracondylar fractures of humerus in elderly comorbid patients treated by closed reduction and percutaneous kirschner wires crisscross fashion. Results: Mean age in our study was 64.5 years, with F:M ratio of 10:6. Left sided involvement was seen in 9 patients while right side was involved in 7 patients. The mean Mayo Elbow Performance Score at final follow up was 91.56 and was excellent in 11(68.75%) patients, good in 4(25%) patients, fair in 1(6.25%) patient. Mean time to union was 6.4 weeks.Conclusion: When aided with appropriate immobilization and timely rehabilitation, closed reduction & percutaneous kirschner wire fixation is a viable option for management of supracondylar fractures in elderly comorbid patients.

Application of elbow arthrography through lateral approach in treatment of elbow fractures in infants

To evaluate the effectiveness of elbow arthrography through lateral approach in the treatment of elbow fractures in infants. The clinical data of 24 infants with elbow fractures admitted between May 2016 and May 2018 were retrospectively analyzed. There were 14 boys and 10 girls with an average age of 1.8 years (range, 2 months to 3 years). The time from injury to admission ranged from 1 hour to 7 days, with an average of 6.7 hours. The preoperative carrying angle was (30.8±4.5)° (range, 24°-41°), and the elbow range of motion was (128.5±4.5)° (range, 125°-134°). Elbow arthrography through lateral approach was used in all cases, including 10 cases of humeral lateral condylar fracture, 6 cases of distal humeral epiphysis fracture, 3 cases of fresh Monteggia fracture, and 5 cases of radial neck fracture. According to fracture types, open reduction with Kirschner wire fixation, closed reduction with plaster cast fixation, or closed reduction with percutaneous Kirschner wire fixation were used. None of the children had adverse reactions such as drug allergy. All patients were follow-up 14-38 months, with an average of 19.6 months. The skin irritation around the needle tail occurred in 2 cases after operation, and the symptoms disappeared after the Kirschner wire was pulled out. The anteroposterior and lateral X-ray films of elbow joint showed that the fractures healed well and no mulunion at the fracture site or premature epiphysis closure was observed. At last follow-up, the carrying angle was (5.2±1.9)° (range, 2°-8°) and the elbow range of motion was (137.1±4.7)° (range, 133°-141°), which were significantly improved when compared with those before operation ( t=22.670， P=0.000； t=11.910， P=0.000). According to Flynn clinical function evaluation standard of elbow joint, 22 cases were excellent, 1 case was good, and 1 case was fair. The excellent and good rate was 95.8%. Elbow arthrography through lateral approach can clearly judge the cartilage damage of the elbow joint surface in infants, and minimize the occurrence of misdiagnosis and missed diagnosis, and can guide the choice of treatment.

A floating fifth metacarpal

A 33-year-old man injured his left little finger following a fall on his left hand with fist closed in a soccer match. He was transferred to the emergency room. The clinical examination revealed deformation, pain and functional impotence of the fifth finger of the left hand. Mobilization and palpation of the digit were painful along and there was no sign of a digital neurovascular lesion. X-rays showed a simultaneous dislocation of the fifth metacarpophalangeal and carpometacarpal joints (A). The treatment consisted of a closed orthopaedic reduction under loco-regional anaesthesia by external manoeuvres directed in the opposite direction of the injury followed by percutaneous Kirschner wires fixation under fluoroscopic guidance (B). The hand was immobilised for six weeks, then the wires were removed and began functional rehabilitation. The three-month check showed a painless stable carpometacarpal and metacarpiphalangeal joints with symmetrical extension and flexion of the little left finger. At the 16-month follow-up, the patient doesn´t complain of stiffness of the left little finger and there was no pain or chronic instability. A floating fifth metacarpal is very rare. In complex dislocation of the little finger metacarpophalangeal joint, the volar plate can be trapped in the joint space, making closed reduction impossible and indicating volar plate entrapment. In general the prognosis is favourable.

Birth-related distal humerus epiphyseal separation: Outcome following surgical management

Distal humerus epiphyseal separation is a rare entity that can present as a birth-related injury. It commonly presents in children younger than 2 years of age and can be a result of a fall or forceful manipulation during delivery. It commonly presents with elbow swelling and decreased movement in newborns. It can be misinterpreted as elbow dislocations due to the lack of ossification in the distal part of the humerus on plain radiographs. Several treatment approaches have been reported in the literature including surgical and nonsurgical treatment modalities. We present a 2-day-old girl with a right distal humerus epiphyseal separation following spontaneous vaginal delivery. An anatomical and a stable reduction of the fracture was the aim in the management of this injury and was achieved using an arthrogram-assisted closed reduction and a single percutaneous Kirschner wire fixation. The patient was followed for 12 months and showed a satisfactory outcome.

Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study.

The aim of this study was to compare two joint sparing Kirschner-wire fixation techniques for displaced proximal phalangeal neck fractures. Forty-six patients with proximal phalangeal neck fractures managed by either percutaneous antegrade flexible intramedullary nailing (Group I) or crossed Kirschner-wires (Group II) were recruited for a randomized prospective comparative study. Clinical and radiological assessment of all patients was done in addition to the Kang scoring system, Disability of Arm, Shoulder and Hand score and total active motion. The mean time for radiological union for both groups was 5.8 weeks. The mean postoperative total active motion, Kang and the Disability of Arm, Shoulder and Hand scores were better in Group I patients, but without any statistically significant differences. Closed reduction and percutaneous Kirschner-wire fixation by a joint sparing approach will yield good functional results with no or minimal complications in proximal phalangeal neck fractures. Level of evidence: II.

A comparative study of volar plate fixation versus percutaneous Kirschner wire fixation in the management of distal radius fracture in adults

A comparative study of volar plate fixation versus percutaneous Kirschner wire fixation in the management of distal radius fracture in adults

Functional Outcome following Headless Compression Screw Fixation for Hamate Fractures.

Hamate fractures can be treated nonoperatively, with the percutaneous Kirschner wire (K-wire) fixation, or with excision of a fractured hook of the hamate. Screw fixation is less popular owing to the risk of iatrogenic ulnar nerve injury. The aim of this study was to present the functional results of patients with hamate fractures treated with headless compression screws (HCS). The primary outcome was the Michigan Hand Outcome Questionnaire (MHOQ) after at least 4 months of follow-up. Nine patients were included in this retrospective cohort study. A median MHOQ total score of 67% was reported (interquartile range [IQR]: 44-76). No complications were found during follow-up. HCS fixation is a safe alternative to treat hamate fractures with good functional outcome. This is a Level IV study.

A study on management of paediatric supracondylar humerus fractures with lateral percutaneous Kirschner wire fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supracondylar fracture of the humerus in children is a common injury encountered in orthopaedic practice. Undisplaced fractures can be managed conservatively, however displaced fractures need proper reduction and adequate fixation for attainment of optimal functional and cosmetic outcomes. The purpose of this study was to evaluate the effectiveness of lateral percutaneous Kirschner (K) wire fixation in the management of displaced supracondylar fractures in relation to achievement of union and functional results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted on 70 patients of either sex with an average age of 5.98 years, presenting to the Orthopaedic Department of S.H.K.M. Government Medical College Hospital, Nalhar, Nuh, Haryana between February 2016 and February 2018, with displaced supracondylar fractures of humerus. All the patients were managed by closed reduction and percutaneous lateral K wire fixation. The patients were followed up for a period of 1 year. The patients were analyzed for union and functional results.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the fractures united with an average time of union of 3.8 weeks. Functional results were assessed using Flynn’s criteria, which were excellent in 58 (82.86%), good in 7 (10%), fair in 3 (4.28%) and poor in 2 (2.86%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Thus results of our study demonstrate that the lateral percutaneous K wire fixation is a safe and effective method of treatment of displaced paediatric supracondylar humerus fractures.&lt;/p&gt;

Augmented External Fixation of Ulnar Carpometacarpal Joint Fracture Dislocations.

Ulnar-sided carpometacarpal (CMC) joint fracture dislocations are relatively uncommon, frequently associated with fractures of the metacarpal base and/or hamate, and often sustained by young male individuals secondary to striking a hard object. The complexity of ulnar-sided CMC fracture dislocations necessitates careful restitution of anatomic alignment and joint congruency for mobility and stability. Miniaturization of the external fixation device has allowed application to the hand. Spanning external fixation utilizes the principles of "ligamentotaxis"-indirect reduction through distraction forces of capsule-ligamentous structures. Treatment options for ulnar-sided CMC fracture dislocations are varied. Our surgical technique involving an external fixation device is reviewed. Clinical and chart review was performed on the last 10 patients undergoing acute surgical repair of ulnar-sided CMC fracture dislocations with intra-articular comminution by the senior author. Surgical technique used percutaneous Kirschner wire fixation and a spanning, miniature, external fixation device. Minimal follow-up was 1 year. Radiographs from the most recent appointment were evaluated by 2 independent reviewers. Patients rated their level of pain and assessed function using a subjective outcome instrument. Mean total active motion, when comparing traumatized digit to same digit in contralateral hand, was 100%. All fractures healed primarily with maintenance of congruent joint space and without radiographic displacement or arthrosis. Patient satisfaction was high and all patients returned to preinjury level of function. Our study demonstrates the use of an external fixation device in the management of ulnar-sided CMC fracture dislocations to be effective in reestablishing and maintaining normal hand anatomy, reducing pain, increasing function, and preserving motion.

Short-term results of open reduction and percutaneous Kirschner wire fixation for Chopart joint dislocation

To investigate short-term clinical efficacy of open reduction and percutaneous Kirschner wire fixation for Chopart joint dislocation. From August 2014 to August 2017, 13 patients with Chopart joint dislocation were treated by open reduction and percutaneous Kirschner wire fixation, including 7 males and 6 female aged from 13 to 58 years old. American Orthopaedic Foot and Ankle Society(AOFAS)criteria system and visual analogue scale (VAS) were applied to evaluate function of foot and ankle at 12 months after operation. All patients were followed up from 8 to 24 months. AOFAS score at 12 months after operation ranged from 65 to 99; 8 cases got excellent results, 4 good and 1 moderate. VAS score ranged from 0 to 4. All wounds were primary healed from 12 to 16 days, and no skin necrosis, infection, Kirschner broken, or other complications occurred. One patient occurred Kirschner's wire loosening at 4 weeks after operation. Open reduction and percutaneous Kirschner wire fixation for Chopart joint dislocation could relieve pain and improve functional activities and obtain satisfactory short-term clinical results.

Outcome of Percutaneous Fixation of Calcaneal Fractures: A Prospective Analysis in an Indian Population

Displaced intra-articular calcaneal fractures can be difficult to treat. Open surgical techniques are associated with wound complications, whereas nonoperative management leads to arthrosis. In the present study, 23 displaced intra-articular calcaneal fractures in 19 patients were treated with closed reduction and percutaneous Kirschner wire fixation. Sanders and Essex-Lopresti classification systems were used. We studied anatomical (Gissane and Bohler angles and width of calcaneus) and functional (Maryland Foot Score and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score) outcomes after 6, 18, and 26 months. Mechanism of injury, fluoroscopy use, time since injury, time delay to surgery, method of reduction, and number of Kirschner wires used were recorded. The mean participant age was 29.5 (17 to 46) years, mean delay to surgery was 7 (2 to 12) days, mean length of surgery was 61 (range 20 to 175) minutes, and mean fluoroscopy time was 115 (range 20 to 254) seconds. All patients were followed for a minimum of 26 months, and the mean duration of follow-up was 32.4 (26 to 36) months. There were 18 (78.26%) joint depression and 5 (21.74%) tongue-type fractures, whereas there were 2 (8.69%) Sanders type II, 13 (56.52%) Sanders type III, and 8 (34.78%) Sanders type IV fractures. The mean Maryland Foot Score and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score at 6 months were 86.7 (81 to 92) and 84.2 (75 to 93), whereas at 26 months, the scores were 87.7 (82 to 93) and 85.1 (75 to 94), respectively. No pin site infections, cases of sural nerve dysfunction, or revision/additional surgery was experienced, and 17 (86.6%) patients were able to return to their original occupation at the end of 26 months.

Mallet Toe of the Hallux Treated by Bridging Suture Technique Using Suture Anchors: A Case Report and Literature Review

An avulsion fracture of the extensor hallucis longus at the distal end of the great toe is called “mallet toe” of the hallux. It is a rare injury and the treatment options are conservative treatment using a splint, percutaneous or open Kirschner wire fixation similar to that in the mallet finger, or suture anchor fixation. We present a case treated by the bridging technique using two suture anchors. A 57-year-old Japanese man injured his left great toe after a fall while walking barefoot on the bed. His great toe was forced into a hyperplantarflexion position. Plain radiography and computed tomography showed a small bone fragment at the base of the dorsal distal phalanx, suggesting an avulsion fracture of the extensor hallucis longus. He was treated by bridging suture technique with two suture anchors. At first, two suture anchors were inserted to the fracture bed of the distal phalanx, and then the bone fragment and extensor hallucis longus tendon were secured with two horizontal mattress sutures. Finally, bridging sutures were performed using the remaining sutures and the sutures used for mattress suturing. He obtained bony union and symmetric range of motion of the interphalangeal joint. This technique allowed us to fix the small bone fragment rigidly and mobilize the interphalangeal joint earlier to preserve the range of motion. It would be a valuable procedure when the bone fragment is small.

Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration.

Background:Supracondylar humerus fracture is the most common fracture around elbow in children. Closed reduction and percutaneous Kirschner wire (pin) fixation is the standard method of managing displaced extension type (Gartland Type II and Type III) supracondylar humerus fractures. The configuration of wires is debatable. Although two crossed K-wires are mechanically stable, there is an inherent risk of ulnar nerve injury. Lateral K-wires – parallel or divergent – are good alternative. This study was aimed at identifying the best configuration for the lateral wires.Materials and Methods:Patients with Gartland type 3 supracondylar humerus fractures were randomized by envelope method to receive closed reduction and K-wire fixation in either a parallel or divergent fashion. The patients were followed up at 3 weeks for wire removal and at 6 weeks and 3 months after surgery. Baumann's angle, functional outcome as per Flynn's criteria, and range of motion were recorded in each visit. Effect of delay in surgery was also evaluated as a secondary outcome.Results:Nineteen patients received fixation with parallel wires and 11 patients had divergent fixation. No loss of reduction was seen in any patient at 3 months. No statistically significant difference was seen in the Baumann's angles and outcome according to Flynn's criteria irrespective of the wire configuration (divergent or parallel). Furthermore, the delay in surgery was also found not to have a significant effect on the functional outcome.Conclusions:Both parallel and divergent K-wire configurations provide satisfactory stability when accurate reduction and adequate fixation of the fracture has been done. Based on the limited number of patients in this study, one configuration cannot be judged to be superior to the other.

Wrist arthroscopy-assisted percutaneous Kirschner wire fixation for fresh scaphoid fractures

Objective To compare the efficacy of percutaneous Kirschner wire fixation assisted by wrist arthroscopy and percutaneous hollow screw fixation under fluoroscopy in the treatment of scaphoid fresh fractures. Methods A retrospective case control study was conducted on the clinical data of 34 patients with scaphoid fresh fractures admitted from April 2009 to January 2016, including 23 males and 11 females, aged 21-44 years, with an average of 28.9 years. There were 21 cases on the right side and 13 cases on the left side. According to the classification of Herbert scaphoid fractures, there were 25 cases of type B2 and nine cases of type B3. The duration from injury to operation was 1-13 d, with an average of 3.2 d. According to the different surgical methods, the patients were divided into arthroscopic assisted percutaneous Kirschner wire fixation group (Group A, 16 cases) and percutaneous hollow screw fixation under fluoroscopy group (Group B, 18 cases). In Group A, four cases were treated with autogenous iliac bone graft, and three cases with scapholunate ligament injury were treated with fixation of scaphoid joint with stage I Kirschner wire. The operation time, hospitalization time, bone healing time, visual analogue scale (VAS), disabilities of arm, shoulder and hand score (DASH), modified Mayo wrist function score, and complications were compared between the two groups. Results The patients were followed up for 6-12 months, averaging 7.5 months. The operation time of Group A and Group B was (52.3±11.2)minutes and (42.5±9.7)minutes, respectively(P 0.05), bone healing time was (11.8 ±1.4)weeks and (13.2±2.4)weeks respectively (P 0.05), and modified Mayo wrist score was (92.1±6.6)points and (85.4±7.5)points respectively (P<0.05). One case of early Kirschner wire loosening occurred in Group A, and one case of nonunion and another of residual scapholunate instability were found in Group B. Conclusion For fresh scaphoid fractures with displacement, percutaneous Kirschner wire fixation assisted by wrist arthroscopy can shorten operation time, promote fracture healing, relieve pain, and improve wrist joint function compared with percutaneous hollow screw fixation under fluoroscopy. Key words: Wrist injuries; Scaphoid bone; Arthroscopy; Fracture fixation, internal

Percutaneous Kirschner wire fixation combined with mini external fixation for treatment of the fifth metacarpal base fractures

Objective To evaluate the clinical outcomes of the minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation in the treatment of the fifth metacarpal base fractures. Methods Eleven patients underwent this minimally invasive technique were enrolled and followed up. All of the patients were diagnosed as the fifth metacarpal base fractures according to the typical X-ray manifestation. In this modified procedure, the fracture was reduced by mini external fixation traction and manual manipulation, and the fifth metacarpal was then fixed to the fourth and third metacarpal by 2 percutaneous Kirschner wires. All the fixation devices were removed 6 weeks postoperatively. The mean follow-up period was 15.7 weeks. X-ray, VAS score, range of motion (ROM) as well as the grip strength of the affected hand were checked for all the patients and the TAM scoring system was used for the function evaluation. Results All the 11 patients achieved satisfied union for the fifth metacarpal base fractures without wire tract infection or screw rod loosening and break. The average postoperative VAS score was 1.13. The patients achieved an averaged 89.3% grip strength compared to the healthy side. According to the TAM scoring system, the results were excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation appears to be an effective and safe procedure for treatment of the fifth metacarpal base fractures. Key words: Fractures,bone; External fixators; Fifth metacarpal base; Minimally invasive technique

Hand function outcome in closed small bone fractures treated by open reduction and internal fixation by mini plate or closed crossed pinning: a randomized controlled trail.

No study in literature clearly gives advantage of one method of surgical fixation of fracture over the other in metacarpal and phalangeal bones of hand comparing wider outcome measures. A randomized controlled trial between closed reduction and percutaneous Kirschner wire fixation or open reduction and internal fixation with mini fragment plates was conducted. A total of 32 patients with 16 in each group were taken in tertiary-level teaching hospital from 2014 to 2016. Four patients lost to follow-up apart from 32 studied. Inclusion criteria were age group 16-60years, fresh (3days) closed shaft fractures of metacarpal and phalanges. Outcome evaluated were time to union of fracture, degree of strength achieved measured with dynamometer, DASH scoring, range of motion of hand and each digit. Both groups were comparable in terms of return to full hand function, union and total range of motion. K wire fixation results were slightly better than plating group in terms of early DASH score and grip strength after fixation. No modality was found to be superior for fixation of small bone fractures of hand. But K wire being cheaper and without inherent complication of plating like scar and tendon irritation, K wire fixation is preferred over plating in shaft fractures of metacarpal and phalanges. Level I Therapeutic study.

Treatment of distal radius fractures with percutaneous pinning

Background Distal radius fracture is one of the common injuries seen in casualty and can be managed by closed reduction and percutaneous pinning. The purpose of this prospective study was to determine the functional results following management of distal radius fractures by percutaneous wire fixation. Materials and methods This study was conducted between June 2014 and June 2017 and included seventy closed distal end radius fractures in 70 patients, comprising 40 (57.14%) males and 30 (42.86%) females. All were managed with closed reduction and percutaneous Kirschner wires fixation. Results The average follow-up was 18 months (range: 12–24 months). All the fractures healed within 10–14 weeks. A total of 36 (51.4%) cases got excellent score, 18 (25.7%) cases were good, 12 (17.1%) cases were fair, and four (5.7%) cases were poor. Most of the patients returned to their preinjury activity level with a 90.7% satisfaction rate. There were 10 cases that experienced pin tract infection and were treated by antibiotic. Conclusion Percutaneous pinning is a simple, minimally invasive technique and is aimed at preventing redisplacement of the distal radius fracture fragments to provide sound bone healing and achieve good radiological and functional results.

Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

BackgroundThe treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures.ObjectiveThe aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged.MethodsA systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed.ResultsFollowing the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded by a government-based noncommercial agency, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).ConclusionsThis study may provide surgical treatment effects evidence for SHFC. The results will assist clinical practice by demonstrating the effectiveness and potential complications of these interventions and might serve as a reference for future clinical trials on the topic.Trial RegistrationPROSPERO CRD42014009304; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=9304 (Archived by WebCite at http://www.webcitation.org/6usiDHzD7)

Comparison of the curative effect and safety of closed reduction and percutaneous Kirschner wire fixation and Kirschner wire fixation in the treatment of supracondylar fracture of humerus

Objective To compare the efficacy and safety of closed reduction and percutaneous Kirschner wire fixation and Kirschner wire fixation in the treatment of children with supracondylar fracture of humerus. Methods 88 children with supracondylar fracture of humerus in our hospital were randomly selected.And they were divided into closed group (n=44) and open group (n=44) by taking computer random sequence method.The closed group was treated with closed reduction and percutaneous Kirschner wire fixation, the open group was treated with Kirschner wire fixation.The treatment effect and safety of the two groups were compared. Results The operation time [(59.47±12.23)min], hospitalization time [(3.46±1.44) d], fracture healing time[(32.46±7.41)d] of the closed group were significantly shorter than those of the open group (t=5.238, 5.395, 7.841, all P 0.05). Conclusion Compared with open reduction and Kirschner wire internal fixation, closed reduction and percutaneous Kirschner wire fixation in the treatment of children with supracondylar fracture of humerus has significant curative effect, it is safe and reliable, which is worthy of promotion in clinic. Key words: Humeral fractures; Comparative effectiveness research