Causes of secondary deformity after surgery to correct Wassel type IV-D thumb duplication

2016 ◽  
Vol 41 (7) ◽  
pp. 739-744 ◽  
Author(s):  
B. He ◽  
G. Nan
Keyword(s):  
Kirschner Wire ◽  
Incomplete Resection ◽  
Flexor Pollicis Longus ◽  
Level Of Evidence ◽  
Thenar Muscle ◽  
Type Iv ◽  
Kirschner Wire Fixation ◽  
Thumb Duplication ◽  
Secondary Deformity ◽  
A2 Pulley

This study was undertaken to document the causes of secondary deformities after surgery for correction of Wassel type IV-D thumb duplication. We carefully dissected and observed the flexor pollicis longus, and bone and joint anatomy in eight patients with secondary deformities after surgical correction. We transferred the flexor pollicis longus and thenar muscle attachments, reconstructed the A2 pulley, released and tightened the joint capsule, and performed osteotomies to correct skeletal malalignment. Kirschner wire fixation was used for 4–5 weeks, followed by brace fixation for 3 months. Patients were followed up for 13–34 months (mean 20 months). According to the Tada scores, the outcomes were good in six patients, and fair and poor in one patient each. The main causes of the secondary deformities were failure to reconstruct the A2 pulley, to transfer the flexor pollicis longus and thenar muscles, and incomplete resection of the radial metacarpal head. Brace fixation after Kirschner wire removal is crucial in preventing secondary deformities. Level of evidence: IV

The anatomy of Wassel type IV-D thumb duplication

2017 ◽  
Vol 42 (5) ◽  
pp. 516-522
Author(s):  
B. He ◽  
G. Liu ◽  
G. Nan
Keyword(s):  
Proximal Phalanx ◽  
Tendon Sheath ◽  
Distal Phalanx ◽  
Level Of Evidence ◽  
Type Iv ◽  
Radial Side ◽  
Thumb Duplication ◽  
Secondary Deformity ◽  
A2 Pulley ◽  
Flexor Pollicis Longus Tendon

We describe Wassel type IV-D thumb duplication anatomy after surgery on 11 affected children (12 hands, seven boys (eight hands) and four girls). We studied the structure and course of the flexor pollicis longus tendon and its action at the joint. Four patients had secondary deformity associated with an absent A2 pulley and a tendon that clung to the radial side of a small thumb. In patients with primary deformity, the flexor tendon sheath became membranous in the A2 area and attached to neighbouring sites on the opposite side of the proximal phalanx. In the proximal A2 area, the tendon divided – one division attached on the ulnar side of the distal phalanx base; the other, the base of the radial side. There was slight ulnar angulation of the distal phalanx on the radial portion of the duplication and slight ulnar angulation on the radial portion. Level of evidence: V

Four-corner arthrodesis employing the native scaphoid as the principal donor graft for advanced collapse deformity of the wrist: technique and outcomes

2016 ◽  
Vol 42 (3) ◽  
pp. 246-252 ◽  
Author(s):  
S. M. Koehler ◽  
C. P. Melone
Keyword(s):  
Revision Surgery ◽  
Work Performance ◽  
Kirschner Wire ◽  
En Bloc ◽  
Level Of Evidence ◽  
Kirschner Wire Fixation ◽  
Donor Graft ◽  
Carpal Height ◽  
Progressive Stage

The purpose of this study was to determine the functional, radiographic, and subjective outcome of the authors’ technique of four-corner arthrodesis using the en bloc excised scaphoid as the principal donor bone graft coupled with Kirschner wire fixation. The study comprised 40 consecutive patients with progressive Stage II and III scapholunate advanced collapse or scaphoid nonunion advanced collapse deformities. Preoperative and postoperative range of motion, grip strength, carpal height, and Michigan Hand Outcomes Questionnaire responses were assessed with a mean follow-up of 4.4 years. At an average of 7 weeks, all patients demonstrated radiographic fusion. Moreover, postoperatively, improvement in the Michigan Hand Outcomes Questionnaire domains of overall function, activities of daily living, work performance, pain, and satisfaction were statistically significant. Complications were few and no patient required revision surgery. In this study, the authors’ technique results in a reliable four-corner arthrodesis with a low expectation of complications or revision surgery. Level of evidence: IV

Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study

2019 ◽  
Vol 45 (6) ◽  
pp. 560-566 ◽  
Author(s):  
Ahmed Fathy Sadek
Keyword(s):  
Comparative Study ◽  
Kirschner Wire ◽  
Level Of Evidence ◽  
Active Motion ◽  
Kirschner Wire Fixation ◽  
Group I ◽  
Wire Fixation ◽  
Total Active Motion ◽  
Prospective Comparative Study ◽  
The Mean

The aim of this study was to compare two joint sparing Kirschner-wire fixation techniques for displaced proximal phalangeal neck fractures. Forty-six patients with proximal phalangeal neck fractures managed by either percutaneous antegrade flexible intramedullary nailing (Group I) or crossed Kirschner-wires (Group II) were recruited for a randomized prospective comparative study. Clinical and radiological assessment of all patients was done in addition to the Kang scoring system, Disability of Arm, Shoulder and Hand score and total active motion. The mean time for radiological union for both groups was 5.8 weeks. The mean postoperative total active motion, Kang and the Disability of Arm, Shoulder and Hand scores were better in Group I patients, but without any statistically significant differences. Closed reduction and percutaneous Kirschner-wire fixation by a joint sparing approach will yield good functional results with no or minimal complications in proximal phalangeal neck fractures. Level of evidence: II

scholarly journals Kirschner wire fixation of Salter-Harris type IV fracture of the lateral aspect of the humeral condyle in growing dogs

2017 ◽  
Vol 30 (01) ◽  
pp. 62-68 ◽  
Author(s):  
Filippo Cinti ◽  
Guido Pisani ◽  
Luca Vezzoni ◽  
Bruno Peirone ◽  
Aldo Vezzoni
Keyword(s):  
Kirschner Wire ◽  
Normal Function ◽  
Kirschner Wires ◽  
Lateral Aspect ◽  
Type Iv ◽  
Kirschner Wire Fixation ◽  
Elbow Fractures ◽  
Humeral Condyle

SummaryObjectives: To evaluate the use of Kirschner wires for treatment of fractures of the lateral aspect of the humeral condyle in growing dogs.Methods: Retrospective analysis of 35 elbow fractures (33 dogs) of the lateral aspect of the humeral condyle treated by insertion of multiple transcondylar and one anti-rotational Kirschner wires. Radiographic and clinical re-evaluations were carried out immediately after surgery, at four weeks and, when required, at eight weeks postoperatively. Long-term follow-up was planned after a minimum of six months. The relationship between different implant configurations and clinical outcome was analysed statistically.Results: Complete functional recovery was seen in 31 elbows (30 dogs), three elbows (2 dogs) had reduction in the range of motion, and one elbow (1 dog) had persistent grade 1 lameness two months postoperatively. Major complications occurred in eight elbows (8 dogs) and all were resolved by implant removal. Implant configuration did not affect outcome. Long-term evaluation in 12 cases with a mean follow-up of four years showed absence of lameness, normal function and no or mild radiographic evidence of osteoarthritis in 11 cases.Clinical significance: Fracture of the lateral aspect of the humeral condyle in growing dogs can be successfully treated by multiple transcondylar convergent or parallel Kirschner wires, resulting in adequate fracture healing.

Reducing the incidence of pin site infection in hand surgery with the use of a protocol from Ilizarov

2021 ◽  
pp. 175319342199131
Author(s):  
Mattia Solari ◽  
Benjamin Kapur ◽  
Harry Benjamin-Laing ◽  
Benjamin R. Klass ◽  
Graham Cheung ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Survival Rates ◽  
Hand Surgery ◽  
Site Infection ◽  
Level Of Evidence ◽  
Kirschner Wire Fixation ◽  
Management Protocol ◽  
Pin Site ◽  
Surgery Department

Reported pin site infection rates in Kirschner wire fixation in the hand and wrist vary from 2% to 35%. In our unit we follow a strict pin site management protocol adapted from the Russian Ilizarov Scientific Centre. This study aims to identify if our current protocol reduces the incidence of pin site infection in hand and wrist surgery, and improves wire survival rates, to a level where exposed wires can be used safely. A retrospective review of 200 patients, treated with 369 percutaneous wires, in our hand surgery department over a 6-year period was carried out. Nine patients (4.5%) were diagnosed with a pin site infection with a wire survival rate of 99.5%.In our unit using our current protocol, results support the safe use of exposed wires with appropriate pin site care initiated in theatre. Adherence to this protocol allows wires to remain in-situ throughout treatment with minimal complications. Level of evidence: IV

scholarly journals External fixation and Kirschner wires in the treatment of paediatric displaced supracondylar femur fractures

2020 ◽  
Vol 14 (4) ◽  
pp. 293-298
Author(s):  
Jin Li ◽  
Changjie Yue ◽  
Hai-Qiang Wang ◽  
Xikai Guo ◽  
Kailei Chen ◽  
...  
Keyword(s):  
External Fixation ◽  
Demographic Data ◽  
Treatment Options ◽  
Kirschner Wire ◽  
Length Of Hospital Stay ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Femur Fractures ◽  
Kirschner Wire Fixation ◽  
Supracondylar Femur Fractures

Purpose Kirschner-wire fixation (KF) and external fixation (EF) for the treatment of displaced supracondylar femur fractures (SFFs) were demonstrated respectively in previous reports. However, there is no paucity of convincing information on better treatment options for children. The aim of this study was to show results of KF and EF in the treatment of paediatric SFFs according to clinical and radiological outcome. Methods A retrospective analysis including 22 displaced closed SFFs was performed. A total of 12 patients were treated with KF, other ten patients were treated with EF. All patients were followed up for at least 24 months. Demographic data, surgical outcomes and postoperative knee function using the Knee Society Score (KSS) scale were evaluated in this research. Results The patients in the KF group were significantly younger than in the EF group (p < 0.001). The KF group had superiority in operative time (p = 0.001), blood loss (p = 0.027) and length of hospital stay (p = 0.001). Clinical healing outcome did not differ between the two groups. The KF group achieved radiological union in a shorter period (p < 0.001), with a better range of movement (ROM) and KSS postoperative score. Conclusion Both KF and EF can achieve excellent outcomes for paediatric SFFs. KF has many advantages in younger children. Level of Evidence IV

Correction of Wassel type IV thumb duplication with zigzag deformity: results of a new method of flexor pollicis longus tendon relocation

2012 ◽  
Vol 38 (3) ◽  
pp. 272-280 ◽  
Author(s):  
C. H. Lee ◽  
H. Y. Park ◽  
J. O. Yoon ◽  
K. W. Lee
Keyword(s):  
Treatment Algorithm ◽  
Suture Technique ◽  
Flexor Pollicis Longus ◽  
Longus Tendon ◽  
Type Iv ◽  
Pull Out ◽  
Thumb Duplication ◽  
Flexor Pollicis Longus Tendon ◽  
Pull Out Suture

The purpose of this study is to present a treatment algorithm and a method of flexor pollicis longus tendon relocation for Wassel type IV thumb duplication with zigzag deformity. Forty-two thumbs in 42 patients were included in this study and the mean follow-up was 4 years. In addition to excision of the extra digit, tendon relocation and metacarpal and/or proximal phalangeal osteotomy were carried out, based on the degree of angulation at the metacarpophalangeal and interphalangeal joints. Tendon relocation was achieved using our pull-out suture technique. The results were assessed using an evaluation form for thumb polydactyly provided by the Japanese Society for Surgery of the Hand. At the time of latest clinical contact, eight cases were rated good, 31 cases fair, and three cases poor. It is useful to decide surgical procedures according to the degree of angulation of the metacarpophalangeal and interphalangeal joints and flexor pollicis longus tendon relocation is important to prevent malalignment at the interphalangeal joint.

Kirschner wire pin site infection in hand and wrist fractures: incidence rate and risk factors

2016 ◽  
Vol 41 (9) ◽  
pp. 990-994 ◽  
Author(s):  
W. F. van Leeuwen ◽  
B. T. J. A. van Hoorn ◽  
N. Chen ◽  
D. Ring
Keyword(s):  
Risk Factors ◽  
Kirschner Wire ◽  
Multivariable Logistic Regression Analysis ◽  
Site Infection ◽  
Kirschner Wires ◽  
Level Of Evidence ◽  
Wrist Fractures ◽  
Kirschner Wire Fixation ◽  
Number Of Patients ◽  
Pin Site

Kirschner wires are widely used for skeletal fixation of unstable fractures, but the pin tracks create a potential pathway through the skin and into the bone for bacteria to cause an infection. We tested the null hypothesis that there are no demographic, patient-related, injury, or treatment variables independently associated with the occurrence of pin site infection after percutaneous fixation of hand and wrist fractures using Kirschner wires. A retrospective review of 1213 patients with one or more fractures of the hand and wrist treated with percutaneous Kirschner wire fixation identified 85 patients (7%) who had additional treatment with oral antibiotics, early pin removal, or reoperation related to a pin site infection. We found no factors were independently associated with higher or lower risks of pin site infection in multivariable logistic regression analysis. Pin site infections – most benign – occur in a notable number of patients and we could not identify any modifiable risk factors. Level of Evidence: III

Stabilization of a Physeal Fracture Using an Orthofix® Partially-threaded Kirschner Wire

1999 ◽  
Vol 12 (02) ◽  
pp. 88-91 ◽  
Author(s):  
D. D. Lewis ◽  
Susan M. Newell ◽  
O. I. Lanz
Keyword(s):  
Internal Fixation ◽  
Successful Treatment ◽  
Kirschner Wire ◽  
Clinical Results ◽  
Rigid Internal Fixation ◽  
Physeal Fracture ◽  
Type Iv ◽  
Salter Harris ◽  
Condylar Fractures

Successful treatment of humeral condylar fractures requires accurate reduction and rigid internal fixation which can be difficult to achieve in toy and/or miniature breed dogs. Stabilization of a Salter-Harris type IV physeal fracture of the numeral condyle was simplified by using Orthofix® partially-threaded Kirschner wire and provided excellent clinical results in a 1.5 kg miniature pinscher

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