Proximal Interphalangeal Arthrodesis of Lesser Toes Utilizing K-Wires Versus Expanding Implants: Comparative Biomechanical Cadaveric Study

2018 ◽  
Vol 40 (2) ◽  
pp. 231-236 ◽  
Author(s):  
Shane D. Rothermel ◽  
Umur Aydogan ◽  
Evan P. Roush ◽  
Gregory S. Lewis
Keyword(s):  
Cortical Bone ◽  
Cadaver Study ◽  
Initial Stiffness ◽  
Fixation Devices ◽  
Fusion Site ◽  
Load To Failure ◽  
Pip Joint ◽  
Interphalangeal Arthrodesis ◽  
K Wires ◽  
Proximal Interphalangeal Arthrodesis

Background: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective procedures often using K-wires for fixation. K-wire associated complications led to development of intramedullary fixation devices. We hypothesized that X Fuse (Stryker) and Smart Toe (Stryker) would provide stronger and stiffer fixation than K-wire fixation. Methods: 12 cadaveric second toe pairs were used. In one group, K-wires stabilized 6 PIP joints, and 6 contralateral PIP joints were fixed with X Fuse. A second group used K-wires to stabilize 6 PIP joints, and 6 contralateral PIP joints were fixed with Smart Toe. Specimens were loaded cyclically with extension bending using 2-N step increases (10 cycles per step). Load to failure and initial stiffness were assessed. Statistical analysis used paired t tests. Results: K-wire average failure force, 91.0 N (SD 28.3), was significantly greater than X Fuse, 63.3 N (SD 12.9) ( P < .01). K-wire average failure force, 102.3 N (SD 17.7), was also significantly greater than Smart Toe, 53.3 N (SD 18.7) ( P < .01). K-wire initial stiffness 21.3 N/mm (SD 5.7) was greater than Smart Toe 14.4 N/mm (SD 9.3) ( P = .02). K-wire failure resulted from bending of K-wire or breaching cortical bone. X Fuse typically failed by implant pullout. Smart Toe failure resulted from breaching cortical bone. Conclusion: K-wires may provide stiffer and stronger constructs in extension bending than the X Fuse or Smart Toe system. This cadaver study assessed stability of the fusion site at time zero after surgery. Clinical Relevance: Our findings provide new data supporting biomechanical stability of K-wires for lesser toe PIP arthrodesis, at least in this clinically relevant mode of cyclic loading.

Assessment of Workspace Attributes Under Simulated Index Finger Proximal Interphalangeal Arthrodesis

2016 ◽  
Vol 138 (5) ◽  
Author(s):  
Paul G. Arauz ◽  
Sue A. Sisto ◽  
Imin Kao
Keyword(s):  
Index Finger ◽  
Model Parameters ◽  
System Parameters ◽  
System A ◽  
Flexion Extension ◽  
Pip Joint ◽  
Interphalangeal Arthrodesis ◽  
Analysis System ◽  
The Impact ◽  
Proximal Interphalangeal Arthrodesis

This article presented an assessment of quantitative measures of workspace (WS) attributes under simulated proximal interphalangeal (PIP) joint arthrodesis of the index finger. Seven healthy subjects were tested with the PIP joint unconstrained (UC) and constrained to selected angles using a motion analysis system. A model of the constrained finger was developed in order to address the impact of the inclusion of prescribed joint arthrodesis angles on WS attributes. Model parameters were obtained from system identification experiments involving flexion–extension (FE) movements of the UC and constrained finger. The data of experimental FE movements of the constrained finger were used to generate the two-dimensional (2D) WS boundaries and to validate the model. A weighted criterion was formulated to define an optimal constraint angle among several system parameters. Results indicated that a PIP joint immobilization angle of 40–50 deg of flexion maximized the 2D WS. The analysis of the aspect ratio of the 2D WS indicated that the WS was more evenly distributed as the imposed PIP joint constraint angle increased. With the imposed PIP joint constraint angles of 30 deg, 40 deg, 50 deg, and 60 deg of flexion, the normalized maximum distance of fingertip reach was reduced by approximately 3%, 4%, 7%, and 9%, respectively.

Effect of K-wire Reuse and Drill Mode on Heat Generation in Bone

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Muturi G. Muriuki ◽  
Arun K. Reddy ◽  
Alex Tauchen ◽  
Robert M. Havey ◽  
Avinash G. Patwardhan ◽  
...  
Keyword(s):  
Cell Death ◽  
Cortical Bone ◽  
Heat Generation ◽  
Kirschner Wire ◽  
Heat Exposure ◽  
Critical Temperatures ◽  
Rotary Drilling ◽  
External Cooling ◽  
K Wires ◽  
Oscillating Mode

Background We examined the effect of Kirschner wire (K-wire) reuse and use of oscillating mode on heat generation within cortical bone. Methods Two trocar-tipped K-wires were drilled through the diaphysis of each of 30 human metacarpals and phalanges: one K-wire was inserted in rotary mode and another in oscillating mode. Each wire was reused once. Thermocouples placed within the dorsal and volar bone adjacent to the K-wire drill path measured temperatures throughout each test. Results Peak cortex temperatures were 25°C to 164°C. Rotary drilling achieves peak temperatures quicker (31 ± 78 seconds vs 44 ± 78 seconds, P = .19) than oscillating drilling, but insertion time is also less, resulting in lower overall heat exposure. This effect is also seen when the K-wire is reused (34 ± 70 seconds vs 41 ± 85 seconds, P = .4). The length of time that cortical bone was exposed to critical temperatures (47°C or more) was significantly higher when a wire was reused (36 ± 72 seconds vs 43 ± 82 seconds, P = .008). Peak temperatures greater than 70°C (a temperature associated with instantaneous cell death) were observed on many occasions. Conclusions Overall heat exposure may be higher if a K-wire is reused or inserted in oscillating mode. In the absence of external cooling, K-wire insertion into cortical bone can easily expose bone to temperatures that exceed 70°C and may increase the risk of osteonecrosis.

scholarly journals Compression test of the mandibular cortical bone: A cadaver study assessing formalin treated or macerated bone specimens

2014 ◽  
Vol 7 (2) ◽  
Author(s):  
János Simonovics ◽  
Péter Bujtár ◽  
Károly Váradi ◽  
Attila Szűcs ◽  
Zsolt Fejér
Keyword(s):  
Cortical Bone ◽  
Compression Test ◽  
Cadaver Study ◽  
Macerated Bone

scholarly journals Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Yaron Sela ◽  
Caitlin Peterson ◽  
Mark E. Baratz
Keyword(s):  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Minimally Invasive Surgical ◽  
Articular Fractures ◽  
Pip Joint ◽  
Joint Flexion ◽  
The Mean ◽  
K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

A Simple Method of Intramedullary Fixation for Proximal Interphalangeal Arthrodesis

2014 ◽  
Vol 53 (6) ◽  
pp. 817-824 ◽  
Author(s):  
Michael B. Canales ◽  
Mark C. Razzante ◽  
Duane J. Ehredt ◽  
Coleman O. Clougherty
Keyword(s):  
Intramedullary Fixation ◽  
Simple Method ◽  
Interphalangeal Arthrodesis ◽  
Proximal Interphalangeal Arthrodesis

Bioabsorbable Fixation Screw for Proximal Interphalangeal Arthrodesis of Lesser Toe Deformities

2017 ◽  
Vol 38 (9) ◽  
pp. 1020-1025 ◽  
Author(s):  
Jascha Armin Wendelstein ◽  
Peter Goger ◽  
Peter Bock ◽  
Reinhard Schuh ◽  
Priv Doz ◽  
...  
Keyword(s):  
Case Series ◽  
Patient Acceptance ◽  
Bony Union ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Bioabsorbable Fixation ◽  
Fixation Devices ◽  
Fixation Screw ◽  
Interphalangeal Arthrodesis ◽  
Standard Fixation

Background: Although standard fixation of proximal interphalangeal (PIP) arthrodesis by K-wire is relatively inexpensive and well established, it does have some drawbacks, making newer fixation devices interesting. The aim of this study was to clinically and radiologically assess the operative correction of the lesser toe deformation in the form of a PIP arthrodesis using a bioabsorbable 2.7-mm fixation screw. Methods: From January 2011 until October 2013, 34 patients underwent a PIP arthrodesis using the TRIM-IT (Arthrex) 2.7-mm fixation screw and were contacted for this retrospective cohort study. At an average of 3.3 years after the operation, 24 patients and 26 toes were evaluated clinically, radiologically, through pedobarography, and a patient-satisfaction survey. Results: Using the PLLA screw for fixation, 84.6% showed bony union of the arthrodesis, and 84.6% were satisfied. Mean AOFAS score was 82.7 points and thus regarded as good. The mean VAS score was 1.3/10. Overall, 73.1% of the toes showed good alignment, and 7.7% had a painless recurrence of deformity and were still satisfied with the intervention. In addition, 34.6% had floating toes, but only 4.2% without Weil osteotomy or encroachment. Further, 3.8% were advised to undergo a revision because of severe misalignment. Conclusion: The 2.7-mm bioabsorbable fixation screw yielded results that were comparable to other fixation devices for PIP fusion fixation regarding success rate, revisions, and patient acceptance. Level of Evidence: Level IV, retrospective case series.

Total Wrist Arthrodesis Using Bowed Crossed K-Wires

1999 ◽  
Vol 24 (4) ◽  
pp. 410-415 ◽  
Author(s):  
A. MINAMI ◽  
H. KATO ◽  
N. IWASAKI
Keyword(s):  
Bone Graft ◽  
Compressive Force ◽  
Iliac Crest Bone Graft ◽  
Bony Union ◽  
Wrist Arthrodesis ◽  
Iliac Bone Graft ◽  
Fixation Devices ◽  
The Mean ◽  
K Wires ◽  
Mean Time

A method of total wrist arthrodesis using a combination of autogenous iliac crest bone graft and “bowed” crossed Kirschner wires is described. The method of bowing the K-wires results in a compressive force on the iliac bone graft. This technique resulted in bony union of 22 wrists in 20 patients. The mean time to union was 12 weeks (range, 8–14 weeks). There were no major postoperative complications. The advantages of this technique are its simplicity, versatility, and reliability which mean that special internal fixation devices are not needed.

Biomechanical Analysis of Screw-Augmented Intramedullary Fixation for Tibiotalocalcaneal Arthrodesis

2007 ◽  
Vol 28 (7) ◽  
pp. 804-809 ◽  
Author(s):  
Patrick J. O'Neill ◽  
Brent G. Parks ◽  
Russell Walsh ◽  
Lucia M. Simmons ◽  
Lew C. Schon
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Pearson Correlation ◽  
Significant Negative Correlation ◽  
Biomechanical Analysis ◽  
Complication Rates ◽  
Initial Stiffness ◽  
Mineral Density ◽  
Tibiotalocalcaneal Arthrodesis ◽  
Load To Failure

Background This study compared intramedullary (IM) fixation for tibiotalocalcaneal arthrodesis with and without a tibiotalocalcaneal augmentation screw. Methods Each specimen in six matched pairs of fresh frozen cadavers underwent tibiotalocalcaneal arthrodesis with an IM nail. One specimen from each pair also received a tibiotalocalcaneal augmentation screw. Initial and final stiffness, load to failure, and construct deformation at failure were calculated with dorsiflexion loading. Bone mineral density of each pair was determined. Statistical analysis was done using a paired Student t-test and a Pearson correlation. Results Initial and final stiffness and load to failure were significantly higher for the tibiotalocalcaneal screw augmented fixation group as compared with the specimens with no additional screw (initial stiffness, 128.0 versus 78.4 N/mm, p = 0.04; final stiffness, 230.9 versus 164.7 N/mm, p = 0.04; load to failure, 875.5 versus 660.2 N, p = 0.03). There was a significant negative correlation between bone mineral density and average construct deformation in the samples without the added tibiotalocalcaneal screw ( r = –0.90, p = 0.02). Conclusions In tibiotalocalcaneal arthrodesis with intramedullary nail fixation, a tibiotalocalcaneal augmentation screw provides more stable fixation. Clinical relevance Use of an augmentation screw as described in this study may lead to lower complication rates, particularly in patients with osteopenic bone.

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