Intramedullary Fixation by Resorbable Rods in a Comminuted Phalangeal Fracture Model

The mechanical rigidity of three different methods of resorbable intramedullary fixation (bone peg, and polyglycolide rods with and without interlocking) was assessed in a comminuted phalangeal fracture model and the results compared with two commonly used internal fixation devices (lateral plate, crossed K-wires) in a cadaver model. Each fixation technique was tested for its biomechanical strength in apex palmar bending, compression and torsion. Failure testing for the three resorbable methods was also done. The results showed that lateral plating provided the best rigidity in apex palmar bending and torsion, followed by intramedullary bone peg fixation. All resorbable intramedullary fixations had rigidity that was at least the same as crossed K-wires. For the torque test, polyglycolide rods with interlocking provided better rigidity than without interlocking. There was no significant difference between the different methods in the compression test, except that the intramedullary bone peg was significantly stiffer than K-wires.

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External Fixation for Comminuted Phalangeal Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80182-3 ◽

1996 ◽

Vol 21 (6) ◽

pp. 760-764 ◽

Cited By ~ 11

Author(s):

F. FITOUSSI ◽

W. Y. IP ◽

S. P. CHOW

Keyword(s):

Mechanical Properties ◽

Internal Fixation ◽

External Fixation ◽

Cadaver Study ◽

Kirschner Wires ◽

Fixation Technique ◽

Lateral Plate ◽

Lateral Plating ◽

Phalangeal Fractures ◽

Phalangeal Fracture

The mechanical rigidity obtained by external fixation in a comminuted phalangeal fracture model was assessed and the results compared with two other types of internal fixation commonly used (lateral plate and crossed Kirschner wires) in a biomechanical cadaver study. Each fixation technique was tested in apex palmar bending, compression and torsion. The results showed that lateral plating provided the best rigidity in apex palmar bending and compression and that external fixation and Kirschner wires showed the same mechanical properties. For the torque test, external fixation provided the best rigidity.

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Fixation for Comminuted Phalangeal Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80183-5 ◽

1996 ◽

Vol 21 (6) ◽

pp. 765-767 ◽

Cited By ~ 25

Author(s):

W. W. LU ◽

K. FURUMACHI ◽

W. Y. IP ◽

S. P. CHOW

Keyword(s):

Mechanical Testing ◽

Kirschner Wire ◽

Fracture Model ◽

Rigid Fixation ◽

Fixation Methods ◽

Lateral Plating ◽

Wire Method ◽

Phalangeal Fractures ◽

Phalangeal Fracture

The rigidities of five fixation methods have been studied with a comminuted phalangeal fracture model. Mechanical testing of compression, bending and torsion were performed for each fixation. Lateral plating with six screws seems to provide the most rigid fixation. If such lateral plating is not practicable, the four-Kirschner wire method would be a satisfactory alternative.

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SALVAGE OF DELAYED UNION OF A PHALANGEAL FRACTURE WITH "A HAIRPIN WIRE"

Hand Surgery ◽

10.1142/s0218810413720325 ◽

2013 ◽

Vol 18 (03) ◽

pp. 431-433

Author(s):

Anoop C. Dhamangaonkar ◽

Hemant S. Patankar

Keyword(s):

Range Of Motion ◽

Proximal Phalanx ◽

Delayed Union ◽

Stable Fixation ◽

Fixation Technique ◽

Articular Fractures ◽

K Wires ◽

Phalangeal Fracture ◽

High Chance

The advantages of using multiple joint sparing antegrade intramedullary wiring for displaced, transverse and short oblique fractures of the small long bones of the hand has been well documented. This technique provides stable three-point fixation and permits early range of motion exercises to prevent hand stiffness. But in some revision cases where there is a breach or deficiency of subchondral bone due to previous intramedullary wiring or in old neglected juxta articular fractures of the metacarpal, proximal phalanx or middle phalanx with disuse osteopenia, there is a high chance of inadvertent joint penetration with intra medullary wiring, inspite of using blunt tipped bent K wires. This could happen intraoperatively or later in the follow up due to collapse of the fracture ends. We describe an innovative fixation technique which ensures stable fixation, no joint penetration and enables early range of motion to prevent hand stiffness.

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Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

10.21203/rs.2.13080/v3 ◽

2020 ◽

Author(s):

Paul Hoogervorst ◽

Tess van Dam ◽

Nico Verdonschot ◽

Gerjon Hannink

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Meta Analysis ◽

Risk Of Bias ◽

Intramedullary Fixation ◽

Common Complication ◽

Fixation Device ◽

Operative Strategy ◽

Fixation Devices ◽

Clavicle Fractures

Abstract Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures (DMCF) using plate osteosynthesis, is internal fixation by means of intramedullary fixation devices. These devices differ considerably in their specifications and characteristics. The aim of this systematic review is to generate an overview of functional outcomes and complications in the management of DMCF per available intramedullary device.Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group.Results Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively (GRADE High). The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are most common (GRADE Moderate). For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35) (GRADE Low). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases (GRADE Very low). Conclusion Although most studies were of low quality, good functional results and union rates irrespective of the type of device are found. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

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Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures – a retrospective multicentre study

10.21203/rs.3.rs-1137765/v1 ◽

2021 ◽

Author(s):

Marcell Varga

Keyword(s):

Surgical Intervention ◽

Complication Rates ◽

Distal Forearm ◽

Forearm Fractures ◽

Kirschner Wires ◽

Paediatric Patients ◽

Fractures In Children ◽

Significant Difference ◽

K Wires ◽

Wire Osteosynthesis

Abstract BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius and forearm fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 30 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.

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712. Activity of Exebacase (CF-301) Against Methicillin-Resistant Staphylococcus aureus (MRSA) Biofilms on Orthopedic Kirschner Wires

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.780 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S320-S320

Author(s):

Melissa J Karau ◽

Suzannah Schmidt-Malan ◽

Jayawant Mandrekar ◽

Dario Lehoux ◽

Raymond Schuch ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Bactericidal Activity ◽

Methicillin Resistant Staphylococcus Aureus ◽

Kirschner Wires ◽

Carrier Solution ◽

Time Points ◽

Significant Difference ◽

Peptidoglycan Cell Wall ◽

The Media ◽

K Wires

Abstract Background Orthopedic foreign body-associated infection can be difficult to treat due to the formation of biofilms protecting microorganisms from both antimicrobials and the immune system. Exebacase (EXE) is a phage-derived lysin which acts as a direct lytic agent by hydrolyzing the peptidoglycan cell wall of Staphylococcus aureus. In this study, the activity of EXE was evaluated in comparison to daptomycin against MRSA biofilms on orthopedic Kirschner wires (K-wires). Methods MRSA strain IDRL-6169 was studied; it has a MIC of 0.5 µg/mL for both daptomycin (DAP) and EXE. Biofilms were formed in 1 mL of 106 cfu/mL tryptic soy broth on 0.5x0.1 mm threaded stainless steel K-wires for 10 hours, after which the wires were removed from the media and placed into 0.04 mL of either DAP or EXE at 0 (vehicle only), 0.098, 0.98, or 9.8 mg/mL. DAP+EXE was also tested, each at 0.098 mg/mL. Bacteria were quantified after 0, 2, 4, 8, and 12 hours of incubation at 37ºC. Testing was performed in triplicate. Results were reported as log10 cfu/K-wire reduction relative to vehicle alone. A 3-log10 cfu/K-wire reduction was considered bactericidal. P-values were calculated using Kruskal–Wallis. Results The bacterial burden of vehicle alone ranged from 5.49- to 6.33-log10 cfu/K-wire at all time points. Bacterial reductions for each treatment compared with carrier solution are shown in the table. DAP showed no bactericidal activity. EXE showed bactericidal activity at all concentrations at all time points studied except 0.098 mg/mL at 8 hours. There was no significant difference between EXE at 0.098 and 0.98 mg/mL at any time point but EXE at 9.8 mg/mL did show superiority over the lower concentrations. DAP+EXE 0.098 mg/mL was bactericidal at all time points. Conclusion EXE showed a rapid effect against MRSA biofilms on orthopedic K-wires apparent within the first 2 hours of exposure and was more active than daptomycin alone at the same concentrations. Disclosures All authors: No reported disclosures.

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