Threaded Intramedullary Nails Are Biomechanically Superior to Crossed K-wires for Metacarpal Neck Fractures

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Midhat Patel ◽  
Paulo Castañeda ◽  
David H. Campbell ◽  
Jill G. Putnam ◽  
Michael D. McKee
Keyword(s):  
Intramedullary Nail ◽  
Kirschner Wire ◽  
Ring Finger ◽  
Displacement Curve ◽  
Sharp Change ◽  
Metacarpal Fractures ◽  
Biomechanical Models ◽  
Wire Fixation ◽  
Point Bend ◽  
K Wires

Background Intramedullary nail (IMN) fixation of metacarpal fractures is an alternative to Kirschner wire (K-wire) fixation. The goal of this study was to compare the biomechanical properties of K-wire fixation with a threaded IMN (InNate; ExsoMed, Aliso Viejo, California). Methods The study design was based on previously described biomechanical models for evaluating metacarpal fractures. Sixteen fresh frozen small finger–matched and ring finger–matched pairs were randomized to either IMN or 0.045 in K-wire fixation after receiving a standardized neck osteotomy. Proper implant placement was confirmed with plain radiographs. Specimens then underwent loading in a 3-point bend configuration. Load to failure (LTF), stiffness, and fracture displacement were recorded. Mechanical failure was defined by a sharp change in the load-displacement curve. Results Age, sex, sidedness (left or right), and digit (ring or small finger) were evenly distributed between groups. The IMN had a significantly higher LTF than K-wires (546 N vs 154 N, P < .001). The K-wire fixation demonstrated plastic deformation between 75 and 150 N. Intramedullary nail stiffness was higher than that of K-wires (155.89 N/mm vs 59.28 N/mm, P < .001). Conclusions When surgical fixation is indicated for metacarpal neck and shaft fractures, the threaded IMN is biomechanically superior to crossed K-wires with the application of 3-point bend.

scholarly journals Retrospective analysis of Intramedullary K-Wire fixation of Metacarpal Fractures

2021 ◽  
Vol 7 (2) ◽  
pp. 22-27
Author(s):  
Dr. Sunil Kumar Kirar ◽  
◽  
Dr. Sanjay Upadhyay ◽  
Dr. Sanat Singh ◽  
Dr. Atul Varshney ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Kirschner Wire ◽  
Functional Results ◽  
Clinical Results ◽  
Metacarpal Fractures ◽  
Kirschner Wire Fixation ◽  
Metacarpal Bones ◽  
Flexion Extension ◽  
Wire Fixation ◽  
K Wires

Introduction: The majority of fractures of the metacarpal bones occur at a young age.Most of thetimes these metacarpal fractures can be treated conservatively in a POP slab(cock up slab)producing good functional results.Surgery was indicated in patients with palmar dislocation of >30°and shortening of >5 mm.Our study aimed to evaluate the clinical results of all metacarpal fracturestreated surgically by intramedullary Kirschner-wire fixation presented in our hospital.Materials andMethods: It was a retrospective study in which we included 50 patients with metacarpalfractures(both open andclosed) that came in our hospital, treated surgically by closed reduction andwere fixed with two intramedullary k-wires. Result: K-wires were removed after 4 weekspostoperatively,under local anaesthesia in the OPD. Metacarpal joint functions (flexion, extension,rotation) were clinically followed up in all patients, on the median periodof6 months (3 months to 9months). In our study, we found in all patients,flexion and extension were normal on bothsides.Conclusion: Closed reduction and intramedullary k-wire fixation of metacarpal bone fracturesproduce good functional results in the longterm. We found a very low rate of complication and thusrecommendthis surgical method for the stabilization of all these types of fractures.

scholarly journals Anatomic Assessment of K-Wire Trajectory for Transverse Percutaneous Fixation of Small Finger Metacarpal Fractures: A Cadaveric Study

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Louis C. Grandizio ◽  
Amy Speeckaert ◽  
Zach Kozick ◽  
Joel C. Klena
Keyword(s):  
Sagittal Plane ◽  
Kirschner Wire ◽  
Ring Finger ◽  
Cadaveric Study ◽  
Sagittal Profile ◽  
Metacarpal Fractures ◽  
Surgeon Training ◽  
Center Position ◽  
K Wires ◽  
Targeting Strategy

Background: The purpose of this cadaveric study is to evaluate the trajectory of percutaneous transverse Kirschner wire (K-wire) placement for fifth metacarpal fractures relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for the treatment of fifth metacarpal fractures. Methods: Using 12 unmatched fresh human upper limbs, we evaluated the trajectory of percutaneous transverse K-wire placement relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for treatment of fifth metacarpal fractures. The midpoint of the small and ring finger metacarpals in the sagittal plane was identified at 3 points. At each point, a K-wire was inserted from the small finger metacarpal into the midpoint of the ring finger metacarpal (“center-center” position). Results: The angle of the transverse K-wire relative to the table needed to achieve a center-center position averaged 20.8°, 18.9°, and 16.7° for the proximal diaphysis, middiaphysis, and the collateral recess, respectively. Approximately 80% of transversely placed K-wires obtained purchase in the long finger metacarpal. Conclusions: These results can serve as a guide to help surgeons in the accurate placement of percutaneous K-wires for small finger metacarpal fractures and may aid in surgeon training.

Kirschner wire fixation for scaphoid fractures: an experimental study in synthetic bones

2011 ◽  
Vol 36 (4) ◽  
pp. 325-328 ◽  
Author(s):  
V. Gokce ◽  
H. Oflaz ◽  
A. Dulgeroglu ◽  
A. Bora ◽  
I. Gunal
Keyword(s):  
Experimental Study ◽  
Kirschner Wire ◽  
Fracture Pattern ◽  
Biomechanical Stability ◽  
Scaphoid Fractures ◽  
Fracture Patterns ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
K Wires

We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30° and 20° oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20° oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.

scholarly journals Kirschner Wire Breakage during Removal Requiring Retrieval

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Kai Yuen Wong ◽  
Rosalind Mole ◽  
Patrick Gillespie
Keyword(s):  
Hand Function ◽  
Kirschner Wire ◽  
Cost Effective ◽  
Middle Finger ◽  
Complication Rates ◽  
Simple Method ◽  
Wire Breakage ◽  
Wire Fixation ◽  
Pin Site ◽  
K Wires

Kirschner wires (K-wires) are widely used for fixation of fractures and dislocations in the hand as they are readily available, reliable, and cost-effective. Complication rates of up to 18% have been reported. However, K-wire breakage during removal is rare. We present one such case illustrating a simple technique for retrieval. A 35-year-old male presented with a distal phalanx fracture of his right middle finger. This open fracture was treated with K-wire fixation. Postoperatively, he developed a pin site infection with associated finger swelling. The K-wire broke during removal with the proximal piece completely retained in his middle phalanx. To minimise risk of osteomyelitis, the K-wire was removed with a novel surgical technique. He had full return of hand function. Intraoperative K-wire breakage has a reported rate of 0.1%. In our case, there was no obvious cause of breakage and the patient denied postoperative trauma. On the other hand, pin site infections are much more common with reported rates of up to 7% in the hand or wrist. K-wire fixation is a simple method for bony stabilisation but can be a demanding procedure with complications often overlooked. It is important to be aware of the potential sequelae.

Lateral condylar fractures of the humerus in children

2018 ◽  
Vol 100-B (3) ◽  
pp. 387-395 ◽  
Author(s):  
R. Ganeshalingam ◽  
A. Donnan ◽  
O. Evans ◽  
M. Hoq ◽  
M. Camp ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Lateral Condyle ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Long Term Follow Up ◽  
Carrying Angle ◽  
K Wires ◽  
Condylar Fractures

Aims Displaced fractures of the lateral condyle of the humerus are frequently managed surgically with the aim of avoiding nonunion, malunion, disturbances of growth and later arthritis. The ideal method of fixation is however not known, and treatment varies between surgeons and hospitals. The aim of this study was to compare the outcome of two well-established forms of surgical treatment, Kirschner wire (K-wire) and screw fixation. Patients and Methods A retrospective cohort study of children who underwent surgical treatment for a fracture of the lateral condyle of the humerus between January 2005 and December 2014 at two centres was undertaken. Pre, intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean age at the time of injury was 5.8 years (0 to 15) with a male:female patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture and the fracture was displaced by > 2 mm in 228 (68%). In all, 235 patients underwent K-wire fixation and 101 had screw fixation. Results There was a higher rate of nonunion with K-wire fixation (p = 0.02). There was no difference in Baumann’s angle, carrying angle or the rate of major complications between the two groups. No benefit was obtained by immobilizing the elbow for more than four weeks in either group. No short-term complications were seen when fixation crossed the lateral ossific nucleus. Conclusions Fixation of lateral condylar humeral fractures in children using either K-wires or screws gives satisfactory results. Proponents of both techniques may find justification of their methods in our data, but prospective, randomized trials with long-term follow-up are required to confirm the findings, which suggest a higher rate of nonunion with K-wire fixation. Cite this article: Bone Joint J 2018;100-B:387–95.

Stabilization of Multiple Metacarpal Fractures: A New Use for the Charnley Toe-Fusion Clamp

1993 ◽  
Vol 18 (2) ◽  
pp. 192-194 ◽  
Author(s):  
K. S. EYRES ◽  
N. KREIBICH ◽  
T. R. ALLEN
Keyword(s):  
Kirschner Wire ◽  
Multiple Fractures ◽  
Simple Modification ◽  
Metacarpal Fractures ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Surgery is often required to ensure adequate reduction and fixation of multiple fractures of the metacarpals. In order to stabilize metacarpal fractures with transverse Kirschner wire fixation, the authors have used a simple modification of the Charnley compression clamp designed for toe fusion.

scholarly journals Kirschner Wire Fixation for Immobilization of the Thenar Flap in an Uncooperative Pediatric Patient: A Case Report

2020 ◽  
Vol 25 (4) ◽  
pp. 287-291
Author(s):  
Hyokyung Yoo ◽  
Yunghoon Kim ◽  
Sung Tack Kwon ◽  
Byung Jun Kim
Keyword(s):  
Pediatric Patients ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Soft Tissue Reconstruction ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Tissue Reconstruction ◽  
Two Stages ◽  
Fingertip Reconstruction

Thenar flap is a commonly used operational method in fingertip reconstruction. It should be maintained for two to three weeks before flap division until the neovascularization is established from the fingertip to the flap. However, immobilization between two stages of operation is challenging especially in uncooperative pediatric patients. A 47-month-old female with a ring fingertip amputation underwent soft tissue reconstruction with thenar flap. Two days postoperatively, the flap’s proximal margin was found disrupted. Flap revision was performed, followed by applying a trans-phalangeal Kirschner wire (K-wire) between the thumb proximal phalanx and ring finger middle phalanx. The flap was successfully divided two weeks after the original operation. The result was aesthetically pleasing, and no complication was observed, including dehiscence, necrosis, limitation of range of motion, and visible scar of the pinning sites. In conclusion, K-wire fixation is a safe and effective method to immobilize thenar flap in uncooperative pediatric patients.

The Intramedullary Kirschner Wire Fixation for Treatment of Distal Metacarpal Fractures

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 69-75 ◽  
Author(s):  
Labler ◽  
Bonaccio ◽  
Oehy
Keyword(s):  
Kirschner Wire ◽  
Minimal Invasive ◽  
Intraoperative Komplikationen ◽  
Metacarpal Fractures ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Die von Foucher et al. beschriebene intramedulläre Kirschner-Drahtosteosynthese distaler Metakarpalfrakturen verbindet die bekannten Vorteile der intramedullären Implantate mit geringem iatrogenem Weichteiltrauma. Bei 38 erfassten Patienten mit einer Frakturdislokation von über 20 Grad und/oder Rotationsfehler haben wir diese minimal invasive Osteosynthesetechnik angewandt. Zur Anwendung kamen zwei vorgebogene Kirschnerdrähte, die nach Aufpfriemen der Kortikalis von der Basis des jeweiligen Mittelhandknochens her und nach Frakturreposition orthograd intramedullär vorgeschoben wurden. Das hockeyschlägerförmig gebogene distale Ende des Drahtes ermöglichte eine zusätzliche Einrichtung des verschobenen distalen Bruchstückes. Intraoperative Komplikationen traten nicht auf. Eine Gipsruhigstellung erfolgte nur für eine Woche. Die elastische Verklemmung der Drähte im Sinne einer inneren Drahtfederschienung erlaubt eine übungsstabile Nachbehandlung. Ab der dritten postoperativen Woche wurde die Hand für zunehmende Belastung freigegeben. Von 38 erfassten Patienten konnten 36 Patienten nachkontrolliert werden. Nach sechs Wochen waren alle Frakturen bis auf eine in guter Stellung konsolidiert. Die Metallentfernung erfolgte ambulant in Lokalanästhesie nach sechs bis acht Wochen. Zu diesem Zeitpunkt erreichten 34 Patienten eine freie Beweglichkeit der Finger. Ausser einer Redislokation und einer distalen Drahtperforation fanden wir keine Komplikationen.

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