K-wire Removal Research Articles

Technique of K-wire localisation and removal using ultrasound guidance

Technique of K-wire localisation and removal using ultrasound guidance

Late collapse of distal radius fractures after K-wire removal: is it significant?

BackgroundThe aim of this study was to find out whether distal radius fractures treated by Kirschner wire (K wire) fixation loose reduction after wire removal and analyze the variables may influence this.Materials and methodsPatients who underwent K wire fixation for unstable fractures of distal radius over a period of 3 years were included in this retrospective study. Fractures were classified according to AO classification. Radiographs taken just prior to removal of K wires and radiographs taken at least 1 month after wire removal were analyzed to study three radiological parameters; Palmar or dorsal tilt, radial inclination and ulnar variance. Loss of these angles was analyzed statistically against variables like age, sex, AO classification and duration of fixation.Results59 fractures were analyzed with mean age of 56 years and male to female ratio of 1:2. Average loss of radial tilt was 2.6°, loss of palmar tilt was 2.6° and loss of ulnar variance was 1.3 mm.ConclusionsWe found that distal radius fractures treated by percutaneous K wire fixation, did not suffer significant loss of reduction of fracture position after removal of wires. This remains true regardless of age, sex, fracture type according to AO type or duration of wire fixation.

Scaphoid Excision and Limited Wrist Fusion: A Comparison of K-Wire and Circular Plate Fixation

The purpose of this study was to compare the clinical outcome, union rate, and complications of a consecutive series of Scaphoid excision and limited wrist arthrodesis performed by a single surgeon using distal radius bone graft and K-wires or circular plate fixation. A sequential series of ten patients(11 wrists) who were stabilized with temporary K-wires were compared to 11 patients (11 wrists) who were stabilized with a circular plate. Minimum follow-up was 1 year. One patient in the K-wire group was converted to a wrist fusion. Six of the remaining ten patients in the K-wire fixation group and 8 of the 11 patients in the circular plate fixation group returned for the following blinded evaluations: Quick DASH, analog pain scale, range of motion, grip and pinch strength, plain x-ray, and multi-detector computed tomography evaluation. One non-union occurred in the K-wire group. There were no non-unions in the circular plate fixation group. There was no difference in any of remaining measures or rate of complications. This study shows that equivalent results can be obtained using circular plate fixation compared to K-wires when equivalent bone graft source and fusion technique are used. If K-wire removal requires a return to the OR, circular plate fixation is more cost-effective.

Do distal radius fractures loose reduction after K-wire removal?

Do distal radius fractures loose reduction after K-wire removal?

Removing k-wires: an audit of practice

Katharine Parker RGN, OrthoDip, RSCN, Sister, Plaster Room, Royal Hospital for Sick Children, Yorkhill, Glasgow Approximately 150 children per year are treated with displaced supracondylar fractures of the elbow at the Royal Hospital for Sick Children (RHSC), Glasgow. This common childhood injury often results from a fall on the outstretched hand. If the fracture cannot be reduced conservatively, it may require to be fixed with percutaneous Kirschner Wires (k-wires) that can be used to stabilise bone fragments. The arm is then placed in a long arm cast for about three weeks. The child returns to the fracture clinic to have the cast taken off and the wires removed. There was concern that children found the procedure of k-wire removal painful and distressing within the fracture clinic setting. This is confirmed by Brown and Fanurik (1996), who suggest that the pain and distress caused by necessary procedures may be overlooked. The aims of the audit were to look at the appropriateness of carrying out this procedure in the fracture clinic, to assess the stress caused to the child and the carer by this procedure and to then develop a protocol.

Preliminary results with Cuénod's osteoligamentoplasty and capsulodesis for treatment of chronic scapholunate dissociation

Until now, the ideal treatment of scapholunate dissociation has not yet been found. Cuénod described an operation with reconstruction of the dorsal part of the scapholunate ligament using a bone-ligament-bone autograft (dorsal trapezoidometacarpal II ligament) and an additional dorsal capsulodesis using the dorsal intercarpal ligament. From December 2000 until January 2002, we operated on twelve patients with symptomatic chronic scapholunate dissociation without signs of osteoarthrosis using Cuénod's procedure. Preoperatively as well as at follow-up patients were evaluated using a traditional wrist score and a DASH-questionnaire in addition to clinical examination. X-rays of both wrists in two planes each and additional stress radiographs were done. All patients had an arthroscopy preoperatively and a CT scan before K-wire removal. The mean follow-up time was twelve months. Clinical follow-up showed good results (traditional wrist score: 77 points; DASH-score: 27 points), but with regard to the good preoperative findings (traditional wrist score: 73 points; DASH-score: 28 points) no significant improvement. Postoperative X-rays showed a correction of static instability in three cases; in four cases we found a recurrent SL gap, which was interpreted as failure of the transplanted ligament. Until now, one patient had to be reoperated by STT-fusion. In our patients, Cuénod's operation showed different results. So, further studies are necessary to find the correct indications for applying this procedure.

Intramedullary Kirschner wire fixation of open or unstable forearm fractures in children.

This retrospective review evaluates the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of open or unstable diaphyseal forearm fractures in 32 children with a mean follow-up of 13 months. Thirty-one patients had an excellent result, and one patient had a good result. Average time to bridging cortex was 3 months. Four patients lacked full pronation and supination, with none lacking >20 degrees, and no patients had evidence of growth-plate arrest. Nine complications occurred in eight patients: lost reduction after K-wire removal (three), refracture (two), deep infection (one), pin-site infection (one), transient anterior interosseous nerve palsy (one), and skin ulcer over buried K-wire (one). Both infections occurred in cases in which the K-wire ends were left outside the skin. Each case of lost reduction occurred in single-bone fixation cases when the K-wires were removed before 4 weeks. In children, intramedullary fixation by using standard K-wires plus cast immobilization provides effective treatment for the problematic open or unstable diaphyseal forearm fracture when closed management has failed. Refinement of the technique may help to avoid complications. We now recommend burying the K-wires under the skin for 3-5 months and stabilizing both the radius and ulna with an intramedullary K-wire.

Intramedullary Kirschner Wire Fixation of Open or Unstable Forearm Fractures in Children

This retrospective review evaluates the efficacy of standard intramedullary Kirschner wires (K-wires) for the treatment of open or unstable diaphyseal forearm fractures in 32 children with a mean follow-up of 13 months. Thirty-one patients had an excellent result, and one patient had a good result. Average time to bridging cortex was 3 months. Four patients lacked full pronation and supination, with none lacking >20°, and no patients had evidence of growth-plate arrest. Nine complications occurred in eight patients: lost reduction after K-wire removal (three), refracture (two), deep infection (one), pin-site infection (one), transient anterior interosseous nerve palsy (one), and skin ulcer over buried K-wire (one). Both infections occurred in cases in which the K-wire ends were left outside the skin. Each case of lost reduction occurred in single-bone fixation cases when the K-wires were removed before 4 weeks. In children, intramedullary fixation by using standard K-wires plus cast immobilization provides effective treatment for the problematic open or unstable diaphyseal forearm fracture when closed management has failed. Refinement of the technique may help to avoid complications. We now recommend burying the K-wires under the skin for 3-5 months and stabilizing both the radius and ulna with an intramedullary K-wire.