Screw Fixation Method through Temporary Kirschner Wire Hole for Coronal Hamate Fracture

Purpose: Hamate coronal body fracture is a rare injury and often associated with dislocation of the carpometacarpal joint. For preserving the carpometacarpal joint, open reduction and rigid internal fixation is needed to displaced fracture. The purpose of this study was to evaluate the outcome of treating hamate coronal fracture with the screw fixation method through a temporary Kirschner wire (K-wire) fixation hole.Methods: From August 2016 to January 2021, eight patients who had displaced coronal hamate body fractures were enrolled. All patients were performed open reduction and multiple K-wires fixations. After that, the cortical screws were then inserted directly into the holes made by removing the K-wires one by one. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue scale (VAS) scores.Results: The average follow-up period was 11.5 months (range, 5–8 months) after surgery, and the bone union was observed at the 8 weeks after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that the average DASH score was 3.95 (range, 0–8.3) and VAS score was 0.8 (range, 0–3).Conclusion: In coronal hamate body fractures, open reduction and screw fixation method through temporary K-wire fixation hole is simple and effective treatment technique.

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Lateral condylar fractures of the humerus in children

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0814.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 387-395 ◽

Cited By ~ 10

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.

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Comparative analysis of surgical outcome of treatment of supracondylar humerus fractures Gartland’s extension type III by using closed reduction and K –wire fixation versus open reduction and K –wire fixation method

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170080 ◽

2017 ◽

Vol 3 (2) ◽

pp. 271

Author(s):

Nilesh Janardan Keche ◽

Abhijit Bhimrao Kale ◽

Binoti Arun Sheth ◽

Ashok Kumar Rathod

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Fixation Method ◽

Elbow Fracture ◽

Supracondylar Humerus Fractures ◽

Wire Fixation ◽

Group 2 ◽

K Wires ◽

Group 1

Background: Supracondylar fractures of the humerus are the most common elbow fracture in children of the age group 4-12 years. The modern approach for its treatment includes closed reduction or open reduction and internal fixation with K wires. The aim of the present study was to evaluate the clinical and radiological results of children who were treated with the two surgical approaches.Methods: In our institute children who underwent surgical treatment for supracondylar humeral fractures by closed reduction or open reduction and internal fixation with K wires and whose data were available with regular follow-up of at least 1 year were included in the study. Each group included 25 children in each. Clinical and radiological outcomes were evaluated and compared among the study groups.Results: The mean age of the patients in both the groups were 6.84 and 6.64 in group 1 and group 2 respectively. Fractures were more in boys compared to girls in both the groups. Most of the fractures were seen on left side with posteromedial displacement of distal fragment in almost 80% in both the groups. Mean change in Baumann’s angle (BA), carrying angle and range of motion (ROM) as compared to normal side in both the groups after 3rd and 9th month of follow ups was found to be not statistically significant. Overall result according to Flynn’s criteria was 60% excellent in group 1 as compared to 52% in group 2. Mean satisfaction score was also more in group 1 children when compared to group 2. Conclusions: Closed reduction with internal fixation with K wires was found to be a better choice of treatment with good functional results.

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Comparative Study of Intramedullary Hammertoe Fixation

Foot & Ankle International ◽

10.1177/1071100717745854 ◽

2018 ◽

Vol 39 (4) ◽

pp. 415-425 ◽

Cited By ~ 13

Author(s):

Caterina Obrador ◽

Marta Losa-Iglesias ◽

Ricardo Becerro-de-Bengoa-Vallejo ◽

Christina A. Kabbash

Keyword(s):

Patient Satisfaction ◽

Functional Outcome ◽

Functional Outcomes ◽

Short Form ◽

Kirschner Wire ◽

Fixation Method ◽

Validated Questionnaires ◽

Sf 36 ◽

Wire Fixation ◽

K Wires

Background: Temporary Kirschner wire fixation (K-wire) is a widely used, low-cost fixation method for the correction of hammertoe deformity. Reported complications associated with K-wires prompted the development of new implants over the past decade. However, there is a lack of literature on comparative studies analyzing functional outcomes using validated questionnaires. The purpose of this study was to analyze functional outcomes in patients who had undergone proximal interphalangeal joint fusion using 2 types of intramedullary implant, the Smart Toe and the TenFuse, and to compare them with the outcomes in patients treated with standard K-wire fixation. Methods: A retrospective review of operative hammertoe correction by a single surgeon was performed in 96 patients followed for more than 12 months. Functional outcome was assessed using the Foot Function Index (FFI), the Short Form 36 (SF-36), and the 10-point visual analog scale (VAS) validated questionnaires. Complications and fusion rates were also evaluated. Several patients in the study underwent corrections in different toes; thus, a total of 186 toes were included in the study. From these, 65 toes (34.9%) were treated with K-wire fixation, 94 (50.5%) with Smart Toe titanium implant, and 27 (14.5%) with TenFuse allograft implant. Results: No statistically significant differences in functional outcome and incidence of complications were observed among the 3 fixation groups, although the 2 intramedullary implants were associated with greater fusion rates and patient satisfaction. Breakage of the Smart Toe implant was significantly higher than that of the other fixations, with 10.6% of implants breaking within the first year postoperatively. SF-36 and VAS scores decreased 12 months after surgery for the 3 types of fixation, with no statistically significant differences observed. Conclusion: The use of Smart Toe and TenFuse implants provided operative outcomes comparable to those obtained using a K-wire fixation and slightly better patient satisfaction. Our results suggest that utilization of these implants for hammertoe correction was a reasonable choice that provided good alignment, pain reduction, and improved function at final follow-up. However, they are more expensive than K-wires. For this reason, in-depth cost-benefit studies would be required to justify their use as a standard treatment. Level of Evidence: Level III, comparative series.

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Biomechanical Comparison of a Novel Method of Tricortical Kirschner Wire Fixation of Distal Chevron Osteotomies of the First Metatarsal Versus Traditional Kirschner Wire and Versus Screw Fixation

Foot & Ankle Specialist ◽

10.1177/1938640020965339 ◽

2020 ◽

pp. 193864002096533

Author(s):

Jie Chen ◽

Natalie R. Black ◽

Randall Morris ◽

Vinod K. Panchbhavi

Keyword(s):

Screw Fixation ◽

Kirschner Wire ◽

Matched Pair ◽

Stiffness Ratio ◽

First Metatarsal ◽

Single Screw ◽

Chevron Osteotomy ◽

Wire Fixation ◽

Load To Failure ◽

K Wires

Introduction: Traditional Kirschner wire (K-wire) stabilization of first metatarsal distal chevron osteotomy involves 1 cortex of fixation; however, unicortical fixation is associated with a high complication rate, including pin migration. A method of K-wire fixation utilizing 3 cortices may be biomechanically superior and potentially equivalent to single-screw fixation. Methods: Cadaveric specimens fixed with tricortical K-wires were tested in both the physiologic and cantilever conditions against specimens fixed with unicortical K-wires (N = 8) and single screws (N = 9) utilizing matched-pair comparison groups. Differences in physiologic and cantilever fixed/intact stiffness ratio and cantilever failure load were determined. Results: The tricortical fixation specimens had a significantly higher stiffness ratio in cantilever loading than the unicortical fixation specimens (60.50% tricortical, 34.17% unicortical, P = .02) but not in physiologic load (15.34% tricortical, 25.75% unicortical, P = .23). In cantilever failure loading, the tricortical fixation specimens had a significantly higher load to failure than the unicortical fixation specimens (132.81 N tricortical, 58.58 N unicortical, P < .01). Stiffness ratio under physiologic load, cantilever load, and ultimate load to failure were not significantly different between tricortical K-wire and screw-fixation groups. Conclusion: Tricortical K-wire fixation for distal chevron osteotomies is biomechanically superior to traditional unicortical K-wire fixation, and equivalent to single-screw fixation. Levels of Evidence: Level V: Cadaver study

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Open Reduction and Intrafragmentary Compression Fixation with External Fixator (the Ichi-Fixator) Treatment of Distal Phalangeal Nonunion

Case Reports in Orthopedics ◽

10.1155/2020/8878002 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Satoshi Ichihara ◽

Yasuhiro Yamamoto ◽

Akira Hara ◽

Masao Suzuki ◽

Yuichiro Maruyama

Keyword(s):

Bone Healing ◽

Open Reduction ◽

Kirschner Wire ◽

Fixation Method ◽

Compression Force ◽

Kirschner Wire Fixation ◽

Hand Fractures ◽

Wire Fixation ◽

Phalangeal Fracture ◽

Interfragmentary Compression

The nonunion of distal phalangeal communized fracture is relatively rare in hand fractures. However, if it occurred, the surgical treatment is quite difficult because of small piece of fragmentations. We developed a new fixation method that involves the insertion of two wires and external wire compression fixation using a metal clamp. The aim of this technique was to increase the compression force between fragments and rigidity of conventional percutaneous Kirschner wire fixation. Here, we present a patient with the nonunion of distal phalangeal communized fracture who was satisfactorily treated with open reduction and percutaneous interfragmentary compression fixation with a linking external wire fixator (the Ichi-Fixator system). Such a treatment that enables compression fixation for communized distal phalangeal fracture of nonunion will clearly boost bone healing. Linked external wire-type compression fixator (the Ichi-Fixator system) enables enhanced security of fixation and facilitates the bone healing.

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Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/a-1559-2684 ◽

2021 ◽

Vol 53 (05) ◽

pp. 462-466

Author(s):

Jun-Ku Lee ◽

Soonchul Lee ◽

SeongJu Choi ◽

Dong Hun Han ◽

Jongbeom Oh ◽

...

Keyword(s):

Distal Phalanx ◽

Bony Union ◽

Dash Score ◽

Medical Database ◽

X Ray ◽

Wire Fixation ◽

Distal Interphalangeal ◽

K Wires ◽

Quick Dash

Abstract Purpose To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation. Patients and methods Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient’s characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated. Results Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0–9) and 25.8 (range: 2–38) to 0.4 (range: 0–2) and 3.4 (range: 0–10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58–114) with three non-union. Conclusion Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410394525 ◽

2011 ◽

Vol 36 (4) ◽

pp. 325-328 ◽

Cited By ~ 4

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.

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Trends in the management of fractures of the distal radius in Ireland

The Bone & Joint Journal ◽

10.1302/0301-620x.101b12.bjj-2018-1615.r3 ◽

2019 ◽

Vol 101-B (12) ◽

pp. 1550-1556 ◽

Cited By ~ 2

Author(s):

R. Mc Colgan ◽

David M. Dalton ◽

Adrian J. Cassar-Gheiti ◽

Ciara M. Fox ◽

Michael E. O’Sullivan

Keyword(s):

Distal Radius ◽

Fracture Fixation ◽

Emergency Surgery ◽

Open Reduction ◽

Plate Fixation ◽

Kirschner Wire ◽

Acute Fracture ◽

Wire Fixation ◽

Increasing Trend ◽

Adult Inpatient

Aims The aim of this study was to examine trends in the management of fractures of the distal radius in Ireland over a ten-year period, and to determine if there were any changes in response to the English Distal Radius Acute Fracture Fixation Trial (DRAFFT). Patients and Methods Data was grouped into annual intervals from 2008 to 2017. All adult inpatient episodes that involved emergency surgery for fractures of the distal radius were included Results In 2008 Kirschner-wire (K-wire) fixation accounted for 59% of operations for fractures of the distal radius, and plate fixation for 21%. In 2017, the rate of K-wire fixation had fallen to 30%, and the proportion of patients who underwent plate fixation had risen to 62%. Conclusion There is an increasing trend towards open reduction and internal fixation for fractures of the distal radius in Ireland. This has been accompanied by a decrease in popularity for K-wire fixation. DRAFFT did not appear to influence trends in the management of fractures of the distal radius in Ireland. Cite this article: Bone Joint J 2019;101-B:1550–1556

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Non-Union in a Fracture of the Shaft of the Distal Phalanx

HAND ◽

10.1016/s0072-968x(82)80049-1 ◽

1982 ◽

Vol os-14 (1) ◽

pp. 85-88 ◽

Cited By ~ 9

Author(s):

L. Read

Keyword(s):

Open Reduction ◽

Kirschner Wire ◽

Middle Finger ◽

Distal Phalanx ◽

Non Union ◽

Shaft Fractures ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Type Of Fracture

Fracture of the shaft of the distal phalanx is less common than more distal fractures involving the tuft: non-union in such a fracture is even more unusual. A case is described in which troublesome non-union of the shaft of the distal phalanx of the middle finger was successfully treated by open reduction and Kirschner wire fixation. The type of fracture and its treatment is discussed: it is emphasised that the principles applied to shaft fractures of the middle and proximal phalanges also apply to the distal phalanx.

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Kirschner Wire Breakage during Removal Requiring Retrieval

Case Reports in Surgery ◽

10.1155/2016/7515760 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

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.

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