First Metatarsal-Phalangeal Joint Arthrodesis: A Biomechanical Assessment of Stability

2003 ◽  
Vol 24 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Joel Politi ◽  
John Hayes ◽  
Glen Njus ◽  
Gordon L. Bennett ◽  
David B. Kay
Keyword(s):  
Plate Fixation ◽  
Kirschner Wire ◽  
High Rate ◽  
Fixation Method ◽  
Materials Testing ◽  
Dorsal Plate ◽  
Kirschner Wires ◽  
First Metatarsal ◽  
Lag Screw ◽  
Kirschner Wire Fixation

Background: First metatarsal phalangeal joint (MTP) arthrodesis is a commonly performed procedure for the treatment of hallux rigidus, severe and recurrent bunion deformities, rheumatoid arthritis and other less common disorders of the joint. There are different techniques of fixation of the joint to promote arthrodesis including oblique lag screw fixation, lag screw and dorsal plate fixation, crossed Kirschner wires, dorsal plate fixation alone and various types of external fixation. Ideally the fixation method should be reproducible, lead to a high rate of fusion, and have a low incidence of complications. Methods: In the present study, we compared the strength of fixation of five commonly utilized techniques of first MTP joint arthrodesis. These were: Surface excision with machined conical reaming and fixation with a 3.5 mm cortical interfragmentary lag screw. Surface excision with machined conical reaming and fixation with crossed 0.062 Kirschner wires. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical lag screw and a four hole dorsal miniplate secured with 3.5 mm cortical screws. Surface excision with machined conical reaming and fixation with a four hole dorsal miniplate secured with 3.5 mm cortical screws and no lag screw. Planar surface excision and fixation with a single oblique 3.5 mm interfragmentary cortical lag screw. Testing was done on an Instron materials testing device loading the first MTP joint in dorsiflexion. Liquid metal strain gauges were placed over the joint and micromotion was detected with varying loads and cycles. Results: The most stable technique was the combination of machined conical reaming and an oblique interfragmentary lag screw and dorsal plate. This was greater than two times stronger than an oblique lag screw alone. Dorsal plate alone and Kirschner wire fixation were the weakest techniques. Conclusions: First MTP fusion is a commonly performed procedure for the treatment of a variety of disorders of the first MTP joint. The most stable technique for obtaining fusion in this study was the combination of an oblique lag screw and a dorsal plate. This should lead to higher rates of arthrodesis.

scholarly journals UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

2015 ◽  
Vol 19 (17) ◽  
pp. 1-124 ◽  
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Caroline Plant ◽  
Nick R Parsons ◽  
Amar Rangan ◽  
...  
Keyword(s):  
Distal Radius ◽  
Locking Plate ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Health Technology ◽  
Kirschner Wires ◽  
Locking Plate Fixation ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Displaced Fracture

BackgroundIn high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation.MethodsIn this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation©(PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness.ResultsThe baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: –1.3; 95% confidence interval (CI) –4.5 to 1.8;p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI –0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (–£727; 95% CI –£588 to –£865), particularly in younger patients.ConclusionsContrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform.Trial registrationCurrent Controlled Trials ISRCTN31379280.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.

Plantar-to-Dorsal Compared to Dorsal-to-Plantar Screw Fixation for Proximal Chevron Osteotomy: A Biomechanical Analysis

2005 ◽  
Vol 26 (10) ◽  
pp. 854-858 ◽  
Author(s):  
Krishn M. Sharma ◽  
Brent G. Parks ◽  
Augustine Nguyen ◽  
Lew C. Schon
Keyword(s):  
Screw Fixation ◽  
Biomechanical Analysis ◽  
Fixation Method ◽  
Materials Testing ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Lag Screw ◽  
Chevron Osteotomy ◽  
Plantar Aspect ◽  
Load To Failure

Background: A change in screw orientation in fixing the chevron proximal first metatarsal osteotomy was noted anecdotally to improve fixation strength. The authors hypothesized that plantar-to-dorsal screw orientation would be more stable than the conventional dorsal-to-plantar screw orientation for fixation of the chevron osteotomy. The purpose of this study was to determine if the load-to-failure and stiffness of the chevron type proximal first metatarsal osteotomy stabilized using plantar-to-dorsal screw fixation were greater than with the more conventional dorsal-to-plantar screw fixation method. Methods: One foot from each of eight matched cadaver pairs was randomly assigned to one of two groups: 1) fixation with a dorsal-to-plantar lag screw or 2) fixation with a plantar-to-dorsal lag screw. A proximal chevron osteotomy was then created using standard technique and the metatarsal was fixed according to previously established method. The bone was potted in polyester resin, and the construct was fitted into a materials testing system machine in which load was applied to the plantar aspect of the metatarsal until failure. The two groups were compared using a two-tailed Student t test. Results: The average load-to-failure and stiffness of the chevron osteotomy fixed with the plantar-to-dorsal lag screw were significantly greater ( p < 0.05) than the group fixed with more conventional dorsal-to-plantar lag screws. Conclusion: Plantar-to-dorsal screw orientation was more stable than the conventional dorsal-to-plantar screw orientation for fixation of the proximal chevron osteotomy. Plantar-to-dorsal screw orientation should be considered when using the chevron proximal first metatarsal osteotomy.

Review of the effect of fixation on complication rate in the base wedge osteotomy

1996 ◽  
Vol 86 (7) ◽  
pp. 327-330 ◽  
Author(s):  
KR Higgins ◽  
KA Shebetka ◽  
LA Lavery
Keyword(s):  
Statistical Difference ◽  
Kirschner Wire ◽  
Metatarsal Bone ◽  
Wedge Osteotomy ◽  
Kirschner Wires ◽  
First Metatarsal ◽  
Kirschner Wire Fixation ◽  
Osteotomy Technique ◽  
Fixation Type ◽  
Independent Variable

The complications of elevation and shortening in the oblique closing base wedge osteotomy of the first metatarsal fixated with either a single AO screw or two 0.062 Kirschner wires were compared. Thirty-three consecutive oblique closing base wedge osteotomies of the first metatarsal bone are evaluated. With the exception of fixation, which is examined as an independent variable, the patients are managed identically with respect to osteotomy technique and postoperative care. The Reese osteotomy guide is used to normalize osteotomy configuration. The authors found no difference in elevation or shortening when comparing an AO screw with 0.062 Kirschner wire fixation. When other variables are controlled, fixation type does not lead to a statistical difference in elevation or shortening.

Combined Intramedullary Kirschner Wire and Intra-Osseous Wire Loop for Fixation of Finger Fractures

1989 ◽  
Vol 14 (2) ◽  
pp. 171-176
Author(s):  
L. K. HUNG ◽  
W. S. SO ◽  
P. C. LEUNG
Keyword(s):  
Mechanical Stability ◽  
Sagittal Plane ◽  
Kirschner Wire ◽  
Bending Moment ◽  
Dorsal Plate ◽  
Kirschner Wires ◽  
Wire Loop ◽  
Dorsal Plating ◽  
Transverse Fractures ◽  
Better Than

An intramedullary Kirschner wire was combined with an intra-osseous wire loop for fixing finger fractures. The mechanical stability of this technique to resist a bending moment in the sagittal plane was compared with four other conventional methods: single loop, loop and an oblique Kirschner wire, crossed Kirschner wires and dorsal plating. It was found that when the applied force was small, the technique was much more stable than the crossed Kirschner wires and was similar to the others. The ability to withstand mechanical failure was much better than most of the methods except the dorsal plate. This technique is recommended for replantations, transverse fractures and short oblique fractures with little comminution.

WRIST ARTHRODESIS IN CHILDREN — A NEW TECHNIQUE: CASE PRESENTATION

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 275-279 ◽  
Author(s):  
Wissam El-Kazzi ◽  
Jörg Bahm ◽  
Frédéric Schuind
Keyword(s):  
External Fixation ◽  
Growth Plate ◽  
Distal Radius ◽  
Soft Tissues ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Carpal Bone ◽  
Neutral Position ◽  
Wrist Arthrodesis ◽  
Kirschner Wire Fixation

Wrist arthrodesis is exceptionally performed in children. The main indication is severe wrist flexion contracture resulting from Volkmann's ischaemia or spasticity. In such cases, a proximal row carpectomy is usually necessary to allow the wrist to be positioned in neutral position. In young children, it is essential to preserve the distal radius growth plate, to prevent physeal closure. In these very particular indications, with high stresses along the stretched palmar soft-tissues, Kirschner wire fixation provides poor stability, and plate fixation is contra-indicated. Radio-metacarpal external fixation is an excellent alternative, preserving the distal radius growth plate and offering sufficient stability. This technique was used in a seven-year-old girl suffering from Volkmann's ischaemic contracture, treated by first carpal bone resection and subsequent arthrodesis with radio-metacarpal external fixation. Bone healing was achieved in three months, with a five years follow-up preservation of the distal radius growth plate.

Comparison of Radiographic Outcomes of Surgical Treatment in Patients with Distal Radial Fractures

2018 ◽  
Vol 20 (6) ◽  
pp. 461-470
Author(s):  
Jakub Florek ◽  
Ireneusz Kotela ◽  
Filip Georgiew ◽  
Witold Zieńczuk ◽  
Tomasz Rzeszutek
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Locking Plate ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Treatment Method ◽  
Kirschner Wires ◽  
Distal Radial Fractures ◽  
Efficient Treatment ◽  
Radiographic Outcomes

Background. Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kirschner wires, open reduction, and fixation with a non-locking or locking plate or with an external device. Choosing a surgical method that produces “better” outcomes may help select the most efficient treatment method. Material and methods. The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires and by open reduction and LCP locking plate fixation. Radiographic assessment was based on images obtained before the surgery, immediately after fracture reduction, and at 6 weeks, 6 months, and 12 months after the procedure. Results. A comparison of the volar tilt angle in patients after fixation with Kirschner wires and LCP plates did not show any statistically significant differences before the surgery or at 6 weeks. A difference in the outcomes was found at 6 and 12 months and it turned out to be highly statistically significant. A comparison of the inclination angle and radial height in patients after Kirschner wire and LCP plate fixation showed statistically significant differences at 6 weeks, 6 months, and 12 months. A comparison of the radiographic outcomes using the Sarmiento classification in patients after Kirschner wire and LCP plate fixation revealed statistically significant differences at all follow-up time points. Conclusions. The radiographic parameters were superior in patients treated by open reduction and LCP plate fixation. The difference was seen with regard to all the parameters studied.

Arthrodesis of the Interphalangeal Joint of the Hallux

2001 ◽  
Vol 91 (8) ◽  
pp. 427-434 ◽  
Author(s):  
Gerard V. Yu ◽  
Frank E. Vargo ◽  
Joel W. Brook
Keyword(s):  
Simple Technique ◽  
Functional Unit ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Kirschner Wires ◽  
Effective Technique ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Common Problems

The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint. (J Am Podiatr Med Assoc 91(8): 427-434, 2001)

Outcome of Proximal Chevron Osteotomy for Hallux Valgus With and Without Transverse Kirschner Wire Fixation

2008 ◽  
Vol 29 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Keun-Bae Lee ◽  
Chang-Young Seo ◽  
Chang-Ich Hur ◽  
Eun-Sun Moon ◽  
Jae-Jun Lee
Keyword(s):  
Hallux Valgus ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Fixation Group ◽  
Chevron Osteotomy ◽  
Kirschner Wire Fixation ◽  
Group I ◽  
Wire Fixation ◽  
Group Ii ◽  
Severe Hallux Valgus

Background: Proximal chevron osteotomy (PCO) for hallux valgus is inherently more stable than the other forms of proximal metatarsal osteotomy, but complications, such as, delayed union, nonunion, and malunion can occur. In this study, we have compared results of two axial Kirschner wire fixation with or without transverse Kirschner wires in PCO for moderate to severe hallux valgus deformities. Methods: A prospective study was conducted on 65 patients (85 feet) that underwent PCO and a distal soft tissue procedure for moderate to severe hallux valgus. Patients were divided into two groups, two axial Kirschner wire fixation (Group I) and two axial and supplementary transverse Kirschner wire fixation (Group II). Group I comprised 41 feet of 32 patients and Group II 44 feet of 33 patients. Results: Average AOFAS scores were 52.8 points in group I and 49.6 points in group II preoperatively, and 92.8 and 89.6 points, respectively, at last followup. Patients were very satisfied or satisfied in 92.7% in Group I and 93.2% in Group II. Average hallux valgus angles in Groups I and II changed from 34.9 degrees and 37.2 degrees preoperatively to 12.3 degrees and 13.9 degrees postoperatively, and intermetatarsal angles in Groups I and II changed from an average of 17.9 degrees and 17.2 degrees preoperatively to 10.3 degrees and 10.4 degrees postoperatively. No significant inter-group differences were found. Conclusion: Supplementary transverse Kirschner wire fixation is not recommended for proximal metatarsal chevron osteotomy since two axial Kirschner wires provided sufficient stability. Level of Evidence: I, Prospective Radomized Study

Preparation of Absorbable Suture Biomaterial Formed by Glycolide/Lactide and Its Application in the Congenital Thumb Deformity Surgery

2021 ◽  
Vol 13 (4) ◽  
pp. 683-693
Author(s):  
Yang Zhou ◽  
Xupeng Lou ◽  
Jialin Zhao ◽  
Zhe Chen ◽  
Fuhuan Le ◽  
...  
Keyword(s):  
Blood Compatibility ◽  
Kirschner Wire ◽  
Collagen Type I ◽  
Fixation Method ◽  
Cell Behavior ◽  
Type I ◽  
Absorbable Suture ◽  
Local Skin ◽  
Kirschner Wire Fixation ◽  
The Difference

Conducting polymers (CPs) can regulate cell behavior and promote the regeneration of damaged tissues, which are widely applied in tissue engineering. In this study, poly(3-hexylthiophene) (PHTP) was first obtained by the catalyst + transfer poly-condensation method, and then, it was mixed with poly(lactide-co-glycolide) (PLGA) to obtain a composite material with superconductivity (PHTP/PLGA). Besides, ferric chloride (FeCl3) was selected as the dopant, and the doping time was changed, so as to obtain 5 PHTP/PLGA materials with different conductivity (10-7 S/cm, 10-6 S/cm, 10-5 S/cm, 10-4 S/cm, and 10-3 S/cm). While PHTP/PLGA was physically characterized, the cell proliferation ability and blood compatibility of this series of materials were further analyzed, and the materials were made into medical sutures for the treatment of congenital thumb deformities. In the experiment, the surface morphology, hydrophilicity, and hydrophobicity of materials with different conductivity would not affect the difference in cell behavior. Using mouse embryonic osteoblasts (MC3T3-E1) as the research objects, increasing PHTP/PLGA conductivity could promote MC3T3-E1 alkaline phosphatase activity cell mineralization, and collagen type I expression. PHTP/PLGA series materials had a low hemolysis rate and were not easily affected by platelet adhesion and activation, meaning that they would not cause coagulation. The material was applied in the direct suture method of hammer deformity, and the results showed that the patient’s deformed thumb had a knot reaction and local skin edge necrosis. After dressing change, it gradually improved. Moreover, the excellent and good rate of deformed thumb based on this material was higher than that of wire extraction method and Kirschner wire fixation method (P < 0.05).

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