K-wire Removal Research Articles

A novel technique for the removal of retained Kirschner wires utilizing a cannulated drill bit

A 35 year-old male with past history of severe open femur and tibia injury presented years after fracture fixation with a symptomatic retained Kirschner wire in his proximal tibia. A cannulated drill bit was used for removal after unsuccessful attempts using hand-held instruments. This case presents a technique for removal of a k-wire retained in bone for several years. This technique can be replicated in similar settings with cannulated drill bits from other commonly used orthopaedic device companies. Intraoperative removal of k-wires can be problematic, however, this technique offers a solution that balances implant removal and limiting destruction of surrounding tissue.

Postoperative Immobilization Period for Pediatric Supracondylar Fractures: The Shorter the Better?

There are now recognized standards of care published by the British and American Orthopaedic Associations which detail key areas of evidence-based recommendations for the treatment of children with displaced supracondylar humerus fractures. Although many aspects of treatment are covered in these recommendations, both the American and British Orthopaedic Associations do not recommend the exact duration of immobilization postoperatively. This study retrospectively compared outcomes of operatively managed supracondylar fractures immobilized postoperatively for short immobilization (SI) defined as 28 days or less, with long immobilization (LI) defined as more than 28 days. The outcomes measured were clinical (deformity, range of motion, and pin site infection) and radiologic (loss of position after the removal of K-wires, Baumann's angle, anterior humeral line, refracture, and signs of osteomyelitis). Demographic data were recorded to evaluate and ensure satisfactory matching of the 2 groups for analysis. The study included 193 pediatric supracondylar fractures over a 4-year period which were treated with manipulation under anesthetic and K-wire fixation. The difference in average time in plaster between the 2 groups was statistically significant (SI: n=27.5d, SD 1.23; LI: n=43.9d, SD 15.29, P =0.0001). Data for operative techniques-closed or open reduction (SI: n=66, LI: n=78, P =0.59), and crossed wires (SI: n=37, LI: n=50, P =0.57) between the two groups showed no statistical significance. There was no statistical difference between the groups for the average number of days postoperatively at which wires were taken out (SI: n=28.9d, SD 5.95, LI: n=30.1d, SD 5.57, P =0.15), number of pin site infections requiring antibiotic treatment (SI: n=3, LI: n=5, P =0.70), or children from each group who were recorded to have regained full range of motion symmetrical to their contralateral arm (SI: n=79, LI: n=99, P =0.74). Our study therefore suggests that shorter immobilization of these patients (SI group) does not yield a higher rate of complications including refracture and malunion.

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%.

Open Reduction Maneuver for Distal Radius Fracture Involving an Intra-articular Sagittal Split

Open Reduction Maneuver for Distal Radius Fracture Involving an Intra-articular Sagittal Split

Talonavicular Dislocations: A Bad Actor Made Worse Without Sufficient Fixation

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The talonavicular joint (TNJ) is critical to midfoot architecture, and traumatic disruptions of this joint threaten the midfoot arch. We sought to better elucidate injuries to the TNJ and understand if transient methods of stabilization after TN dislocations (TNDs), such as closed/open reduction with or without percutaneous pinning resulted in different radiographic and clinical outcomes when compared to more permanent methods such as bridge plating or primary arthrodesis of the TNJ. Methods: We retrospectively identified skeletally mature patients from one tertiary level 1 trauma center treated for midfoot injuries between 2002-2022. Patients with isolated or concomitant TNDs were included. Demographics, treatment, radiographic outcomes, and patient reported outcomes (PROs) were recorded. Patients who underwent temporary fixation methods (closed/open reduction and trans-articular pinning with k-wire removal at 6-8 weeks) were compared to those with permanent fixation (bridge plating or primary arthrodesis). Primary outcome was reoperation, including fusions and amputations. Secondary outcomes were radiographic arch measurements (Meary’s angle [MA], calcaneal inclination angle [CIA]) and PROMIS measures of physical function, pain interference, and anxiety. Sixty-two patients and 66 feet were included (Table 1). Average follow up was 2 years. Results: TNDs manifested as both pure dislocations (18) and in conjunction with associated injuries: chopart dislocations (5), talar head/body fractures (23), navicular fractures (35), and subtalar dislocations (25). Twelve were a part of Hawkins IV talar neck fracture dislocations (18%). Forty-two patients were treated with temporary fixation (64%). Injuries treated with transient fixation had higher mean change in MA from immediately postop to final follow-up (-7.9° v -1.1°, p=0.006). They also exhibited significantly different MA and CIA values at final follow-up (7.8° v -1.4°; 17.3° v 21.3°, p&lt; 0.03). Nearly two thirds required reoperation; 32% underwent fusion and 7% required amputation. Fixation method had no significant association with PROMIS scores, but those with temporary fixation methods trended toward lower final PF scores (34.9 v 41.1, p=0.11). Conclusion: TNDs are generally the result of high energy mechanisms, often occurring in combination with other significant mid/hindfoot injuries. Reduction and fixation method of these injuries should be carefully considered to avoid potential ramifications of loss of normal arch and midfoot sag.

Dual Parallel Intramedullary K-Wires for Arthrodesis of the Finger Distal or Thumb Interphalangeal Joints.

K-wire arthrodesis methods are commonly used during arthrodesis of the finger distal interphalangeal (DIP) or thumb interphalangeal (IP) joints. Here we propose an advantageous approach involving dual parallel intramedullary K-wires with the K-wire tips cut to bury underneath the skin. From January 2017 to December 2021, 35 patients (43 joints) underwent finger DIP or thumb IP joint arthrodesis using this method. Radiographic outcomes were evaluated, while functional outcomes were assessed using the visual analogue scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Patients with at least 1 year follow-up were analyzed. The preoperative and postoperative functional results were analyzed using the paired t-test. Arthrodesis union was achieved in 41/43 joints (95.3%). We treated 10 thumb IP joints and 33 finger DIP joints, for which the underlying cause was osteoarthritis and trauma in 37 and six digits, respectively. The average time of K-wire removal was 8.9 (range, 7-10) weeks after surgery. Twenty-four patients (27 joints; 22 women, two men) had at least 1 year follow-up (mean 15.9; range, 12.5-40.8) months. For patients with bone healing, the VAS score improved from 6.6 (range, 5-8) to 0.6 (range, 0-1) (p < 0.001), and the QuickDASH score improved from 57.9 (range, 31.8-77.3) to 14.7 (range, 6.8-20.5) (p < 0.001) at final follow-up. Both of the two failure cases were in the thumb. There were no other complications. This technique is simple and cost-effective and achieves a good union rate. The advantages include the ability to choose variable K-wire sizes according to the size of the medullary canal and the ease of postoperative care.

An Open Hallux Interphalangeal Joint Dislocation: A Rare Case

Background: The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident.&#x0D; Case Report: A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op.&#x0D; Conclusion: Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.

Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children.

The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC. There were no significant differences between PKRC and PKRNC with regard to preoperative angulation ( P = 0.556). The operation time in the PKRC group was significantly shorter than that of the PKRNC group ( P = 0.023). There was no significant difference in the displacement angle when compared between the two groups on the first day and 1 month after surgery ( P = 0.617, 0.72). The Mayo elbow performance score of the elbow joint function did not differ significantly between the two groups ( P = 0.587). Although the hospital stay was not significantly different between groups (4.81 ± 1.07 vs. 4.16 ± 1.59 days; P = 0.067), the PKRNC group required a second hospitalization to remove the elastic intramedullary nail 3 months after the operation. PKRC and PKRNC both achieved satisfactory outcomes for radial neck fractures in children. The operation time in the PKRC group was significantly lower than in the PKRNC group. PKRC does not require reoperation to remove internal fixation. Therefore, PKRC is recommended for radial neck fractures in children.

Multifocal percutaneous pin fixation of talar neck fractures: An alternative to ORIF in the polytraumatized patient

PurposeUnique anatomy, precise articulations, fragile vascularity, and the demand for anatomic reduction make talar neck fractures challenging to treat, whether with screws and/or plates. Multifocal percutaneous pin fixation (MPPF) offers an alternative to ORIF, particularly in the polytraumatized patient. MethodsUnless an open lateral wound or medial malleolus fracture was present, a standard anteromedial approach was performed. K-wires placed within the talar head were used as joysticks to facilitate and finalize reduction. At least 3 wires were placed medially and 2 laterally across the talar neck. Incisions were closed in 2 layers, and either a well-padded short leg splint or adjunctive ankle-spanning external fixation was utilized. Patients remained non-weightbearing until K-wire removal in the office at approximately 6–8 weeks postoperatively. ResultsMPPF was performed in 7 patients, the majority of whom were female (6 of 7). The average patient age at the time of injury was 30.3 years (range 17–51 years). The median time of final follow up was 27 months. Comminution was present in all patients. Avascular necrosis (AVN) developed in 3 patients and non-union occurred in 2 patients. All patients developed subtalar posttraumatic arthritis, and 6 additionally developed tibiotalar arthritis. No patients underwent talectomy or osteotomy, and there were no superficial pin site infections or loosening of pins prior to scheduled removal. ConclusionsObtaining and maintaining an adequate reduction is possible with minimal soft tissue compromise through MPPF. Despite the complexity of the series, outcomes utilizing MPPF are comparable to those reported in the literature.

Analysis of the factors affecting pain level during K-wire removal among pediatric elbow fractures.

Our aim was, to analyze the reasons for possible increased pain during the removal of the Kirschner wires from the elbows of children. From February 2021 to December 2021, 573 patients with elbow fractures were treated. In total, 150 patients were analyzed prospectively. No action was taken to reduce pain during the removal of Kirschner wires. The pain status of the patients was evaluated according to the Wong-Baker FACES Pain Rating scoring system (WBAS), the Numeric Rating Scale (NRS) for the pain system and the pulse and oxygen saturation measured by the pulse oximeter on the finger. Measurements were performed before, during, immediately after and 30 min after the procedure. There were 119 patients with a diagnosis of supracondylar humerus fracture and 31 patients with a diagnosis of lateral condyle fracture. The mean age of treated patients was 7.1 years (1-15 years). Of the patients, 93 were boys and 57 were girls. In the measurements made according to the sex difference, it was determined that there was a statistically significant increase in the WBAS scores measured both before the procedure ( P = 0.032) and during the removal ( P = 0.017), and also in the pulse measurements taken 30 min after the removal in girls ( P = 0.034). A statistically significant difference was found in both the WBAS score during removal ( P = 0.025) and the NRS scores 30 min later ( P = 0.048) in the procedures performed on the right elbow. We found a statistically significant increase in the pain parameters we evaluated in girls, right extremity fractures, the group over 8 years old and when both parents were with the child during the K-wire removal procedure. In light of these findings, physicians should consider the above-mentioned conditions before starting the procedure to ensure a less painful and positive experience.

Comparing exposed and buried Kirschner wires in fixation for pediatric supracondylar humerus fractures: A propensity score-matched study.

To thoroughly compare the outcomes between exposed and buried Kirschner wires (K-wires) in fixation for pediatric supracondylar humerus fractures. We examined patients who underwent surgery at our institution between January 2007 and June 2021. We investigated their age, sex, fracture pattern, number of K-wires used, whether they were exposed or buried, operative time, postoperative complications, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and perioperative radiographic parameters. After propensity score matching, intergroup comparisons were performed to assess the differences in postoperative complication rate, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and loss of reduction. Propensity score matching resulted in 43 pairs in both groups. Although more patients complained of skin irritation in the buried K-wire group, there was more backing out of the K-wire in the exposed K-wire group (p < 0.01). There were no significant differences in other complications. There were more outpatient visits in the buried K-wire group (p < 0.01). The duration from surgery to K-wire removal and the total length of hospitalization were significantly longer in the buried K-wire group (p < 0.01). There was no significant difference in the loss of Baumann's angle (p = 0.61), tilting angle (p = 0.48), or the development of rotation (p > 0.99) between groups. More outpatient visits and longer lengths of hospitalization in the buried K-wire group may lead to increased costs and burden on parents.

Internal Fixation of Finger Fractures: Field Sterility for Surgery and Earlier Removal of K-Wires Are Safe.

Field sterility for K-wire insertion outside the main operating room is much cheaper and greener (ie, there is less waste). It permits increased access to more affordable surgery because unnecessary sedation and full sterility are eliminated. Early pain-guided protected movement of K-wired finger fractures at 3 to 5days leads to less stiffness. It will not result in loss of reduction or infection around K-wires if patients avoid "pain" (ie, do not perform movements that hurt). Early protected movement and early removal of K-wires at 2 to 4weeks contribute to less stiffness after operative hand/finger fracture reduction and stabilization.

Closed isolated anterolateral calcaneal dislocation: a case report

BackgroundComplete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.Case presentationA 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.ConclusionPatients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.

Type III Supracondylar humeral fracture in children treated by 3 lateral versus 2 cross K-wire fixation, Aden, Yemen

Background: Supracondylar fractures of humerus are the most common elbow fractures seen in children. Objective: To describe the patients’ condition and to evaluate the treatment and the outcome. Materials and method: We retrospectively reviewed the records of 40 consecutive patients with 40 displaced, supracondylar fractures of the humerus treated between January 2019 and December 2020, in Aden. The obtained data were sex, age, side of injury, time between injury and fixation, trial of reduction and complications. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations; Fisher test was used and p-value &lt; 0.05 was considered as statistically significant. The statistical software package SPSS version 17 was used. Results: The total study patients were 40 patients. Twenty-one (52.5%) were males and 19 (47.5%) were females. The age of the patients ranged between 2 to 10 years and the mean age was 6.6 ± 2.1 years. Twenty-four (60%) had the fracture on the right arm, and 16 (40%) had on the left arm. All the patients underwent surgery within 24 hours of injury. The mean time was 8.1 ± 4.5 hours. There were 11 (27.5%) cases of once trial reduction, 14 (35%) of twice trial reduction and 15 (37.5%) of three times trial reduction. The average removal of K-wires was 3.55 weeks. Twenty-six (65%) patients were treated by III lateral K-wires fixation and 14 (35%) were treated by crossed K-wire fixation. Post-operatively, (17.5%) patients got neuropraxia in the crossed K-wire group (n = 14), and none in the III lateral K-wire group. Two (5%) patients got angulation, one in the crossed K-wire group (n = 14), and one in the III lateral K-wire group (n = 26). Cupitus varus was seen in 2 (5%) patients in the crossed K-wire group and 2 (5%) in the III lateral K-wire group. Stiffness was found in the III lateral K-wire group with 2 (5%) patients. Conclusion: The delay in surgical treatment may cause a number of complications. Key words: Treatment, supracondylar fracture, humerus, children, Aden

Type III Supracondylar humeral fracture in children treated by 3 lateral versus 2 cross K-wire fixation, Aden, Yemen

Background: Supracondylar fractures of humerus are the most common elbow fractures seen in children. Objective: To describe the patients’ condition and to evaluate the treatment and the outcome. Materials and method: We retrospectively reviewed the records of 40 consecutive patients with 40 displaced, supracondylar fractures of the humerus treated between January 2019 and December 2020, in Aden. The obtained data were sex, age, side of injury, time between injury and fixation, trial of reduction and complications. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations, Fisher test was used and p-value &lt; 0.05 was considered as statistically significant. The statistical software package SPSS version 17 was used. Results: The total study patients were 40 patients. Twenty-one (52.5%) were males and 19 (47.5%) were females. The age of the patients ranged between 2 to 10 years and the mean age was 6.6 ± 2.1 years. Twenty-four (60%) had the fracture on the right arm, and 16 (40%) had it on the left arm. All the patients underwent surgery within 24 hours of injury. The mean time was 8.1 ± 4.5 hours. There were 11 (27.5%) cases of once trial reduction, 14 (35%) of twice trial reduction and 15 (37.5%) of three times trial reduction. The average removal of K-wires was 3.55 weeks. Twenty-six (65%) patients were treated by III lateral K-wires fixation and 14 (35%) were treated by crossed K-wire fixation. Post-operatively, (17.5%) patients got neuropraxia in the crossed K-wire group (n = 14), and none in the III lateral K-wire group. Two (5.0%) patients got angulation, one in the crossed K-wire group (n = 14), and one in the III lateral K-wire group (n = 26). Cupitus varus were seen in 2 (5.0%) patients in the crossed K-wire group and 2 (5.0%) in the III lateral K-wire group. Stiffness was found in the III lateral K-wire group with 2 (5.0%) patients. Conclusion: The delay in surgical treatment may cause a number of complications. Key words: Treatment, supracondylar fracture, humerus, children, Aden

Displaced Distal Radius Fracture in Children, Single vs Double K-Wire Fixation

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials &amp; Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation

246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)

Abstract Aim BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma &amp; Orthopaedics outpatient setting in the United Kingdom. Method A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines. Results Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed. Conclusions Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.

Comparison of Results Based on the Number of Kirschner Wires of Different Diameters in Antegrade Intramedullary Fixation of Fifth Metacarpal Neck Fractures

Purpose: The purpose of this study was to compare the clinical and radiological results of patients with fifth metacarpal neck fractures using different sizes and numbers of Kirschner wires (K-wire).Methods: A single institutional retrospective review identified 67 patients with a fifth metacarpal neck fracture between January 2015 and July 2020. The minimum follow-up time was 6 months and they were all treated within 6.4 days of the initial injury. Either one K-wire (1.6 mm), two K-wires (1.1 mm), or three K-wires (0.9 mm) was used. We analyzed the bone union period, and K-wire removal period, duration of surgery, total active motion, intramedullary diameter, pre/postoperative shortening, and pre/postoperative angulation clinically. We used a Method of Shortening Stipulated to measure shortening and the Medullary Canal-lateral view method for angulation. The intramedullary diameter was measured in the mid-shaft of the fifth metacarpal bone in the coronal view. Total active motion was measured at the time of follow-up in our outpatient department.Results: Clinical and radiological parameters showed no statistically significant differences. Even though it did not present a statistical significance, the absolute mean duration of surgery was the shortest in a single K-wire group. Conclusion: The clinical and radiological outcomes of surgery were comparable regardless of the number of K-wires inserted. However, we could look forward to gaining potential benefit from shortened operation time in a single K-wire group. Since stable fixation can be obtained even if one K-wire is used, inserting one thick K-wire into the intramedullary canal can be an alternative according to the surgeon’s preference.

Down to the wire: Patient and family experiences of k-wire removal in a paediatric specialist clinic

IntroductionK-wire removal is a common procedure in the paediatric outpatient clinic that is a source of pain and anxiety. This study examined the current parental experience of k wire removal. MethodsTwenty-six parents of children having k-wires removed in a paediatric outpatient clinic were asked to complete an electronic survey immediately post procedure. Questions explored prior knowledge, sedation and analgesia for the procedure. Data analysis used descriptive statistics. ResultsVerbal information from the ward prior to the procedure was the greatest information source for parents 22/26(85%). Thirty-eight % (10/26) of parents had expected sedation but only 6/10(23%) reported receiving sedation information. Only 7/26(27%) of parents reported their child receiving analgesia from themselves or medical staff pre-procedure. DiscussionParents recommended the need for more procedural information beforehand, especially regarding pain and sedation. Parents were unaware of the option of sedation and wanted analgesia before the procedure.

Considerations When Performing Arthrodesis in the Scleroderma Hand.

Hand deformities secondary to scleroderma can limit activities of daily living and be associated with substantial disability. This study aimed to evaluate the outcomes following arthrodesis performed to treat digital contractures secondary to scleroderma. We performed a retrospective review of all patients with scleroderma who underwent arthrodesis by a single surgeon from 2015 to 2020. We collected demographic information, operative variables, and outcomes variables. Our primary outcome was occurrence of any postoperative complication, which we defined to include wound dehiscence, digital ischemia, malunion, nonunion, cellulitis, and osteomyelitis. We calculated descriptive statistics and performed all analyses at the joint level. We identified 9 patients who underwent arthrodesis of 19 joints. All patients were women with a mean age of 55.3 years. At the time of surgery, most patients were taking disease-modifying antirheumatic drugs (DMARDs). Kirschner wires (K-wires) were used in most cases (n = 18), 15 of which were removed uneventfully at an average of 4.8 months after surgery. With a mean follow-up time of 15.4 months, the overall complication rate was 5.3% (n = 1). This patient developed digital ischemia in 1 of 4 operative digits, which became gangrenous and required amputation. Our study suggests that arthrodesis can be performed safely in the scleroderma hand, even when patients are taking DMARDs. Given the uneventful K-wire removal in all joints and the high risk of exposure of buried hardware in this population, we recommend nonpermanent placement of K-wires. Hand surgeons may consider arthrodesis in the scleroderma hand before proceeding to revision amputation.