Temporary K-wire Fixation Research Articles

Postoperative Computed Tomography–Based Control of Syndesmotic Screws

Ab stract Purpose: Skeletal reconstruction and position of osteosynthetic devices, especially of the syndesmotic screws, were controlled postoperatively in order to check the accuracy of surgical intervention and of intraoperative C-arm control. Patients and Methods: This is a prospective, nonrandomized study of a closed series of 37 patients with ankle fractures AO type B and C who were treated according to the AO principles and in whom a syndesmotic screw was used. All patients underwent postoperative computed tomograpy. Results: Intraoperative radiography was judged to be normal by all surgeons. Retrospectively, it was considered to be abnormal in nine patients – verified by computed tomography in six –, normal in 22 patients, and technically imperfect in six. So, intraoperative radiography proved to be erroneous in nine patients (24.3%). Computed tomography revealed a less than perfect result in six of 37 patients (16.2%). In four patients this was due to pure anterior subluxation of the fibula. None of 13 patients who had a temporary Kirschner wire (K-wire) fixation of the fibula intraoperatively had a malposition, whereas six out of 24 patients (25%) without K-wire did show a malposition. A revision operation was carried out in five patients (13.5%). Conclusion: It can be stated, that the positioning of a syndesmotic screw is technically delicate, that intraoperative two-dimensional C-arm control is not sufficient to detect malpositions of the screw and/or the lateral malleolus, and that prior to screw placement temporary K-wire fixation of the fibula is mandatory. If plain radiography leaves any doubt about the quality of reduction, postoperative computed tomography is indicated.

Commentary: Excision of the trapezium

As noted by Davis, Brady, and Dias in their report,1 painful degeneration of the carpometacarpal joint of the thumb is a problem seen frequently by hand surgeons and often requires surgical reconstruction. They report that trapezium excision in conjunction with temporary K-wire fixation and cast immobilization is just as effective in relieving symptoms as the more extensive placement of a soft-tissue spacer and ligament reconstruction.

Ｇａｌｅａｚｚｉ骨折の治療経験

We report 10 cases of acute Galeazzi fracture-dislocations which we treated during a three years period. The mean age of the patients was 51.4 years, and six of them had classical Galeazzi fractures, and four had Galeazzi-equivalent fractures. Three fractures were treated by closed reduction and percutaneous pinning, three with open reduction and internal plate fixation, three with external fixation and bone graft, and one with open reduction and internal K-wire fixation.All fractures were evaluated using Kanazawa's criteria. Results were judged to be excellent in five cases, fair in three, and poor in two. The two poor in two. The two poor cases were older women, one with osteoporosis the other with a comminuted fracture of the distal third of the radius.Computerized tomography was valuable in diagnosing subluxation of the distal RU joint.Postoperative temporary K-wire fixation of the distal RU joint in the neutral forearm position was effective.

母指以外のＣＭ関節脱臼骨折

Seven cases with fracture-dislocation of the 4th and 5th carpometacarpal joints were treated during the past eleven years. These cases were followed for an average of 3 and their years and 3 months. Six cases were male whereas one case was female, ages ranged from 20 to 60 years (average, 33.9 years). Closed reduction was performed in fresh cases, following cast immobilization. Open reduction was performed in 1 fresh case and 5 old cases, following temporary K-wire fixation. In the old cases 7 months after injury, it was very difficult to reduce the dislocation, even surgically. All cases had excellent results.