scholarly journals Comparison of Results Based on the Number of Kirschner Wires of Different Diameters in Antegrade Intramedullary Fixation of Fifth Metacarpal Neck Fractures

2021 ◽  
Author(s):  
Dong Chul Lee ◽  
Jung Hyun Park ◽  
Sung Hoon Koh ◽  
Jin Soo Kim ◽  
Kyung Jin Lee ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Operation Time ◽  
Lateral View ◽  
Kirschner Wires ◽  
Active Motion ◽  
Intramedullary Canal ◽  
Duration Of Surgery ◽  
Total Active Motion ◽  
K Wires

Purpose: The purpose of this study was to compare the clinical and radiological results of patients with fifth metacarpal neck fractures using different sizes and numbers of Kirschner wires (K-wire).Methods: A single institutional retrospective review identified 67 patients with a fifth metacarpal neck fracture between January 2015 and July 2020. The minimum follow-up time was 6 months and they were all treated within 6.4 days of the initial injury. Either one K-wire (1.6 mm), two K-wires (1.1 mm), or three K-wires (0.9 mm) was used. We analyzed the bone union period, and K-wire removal period, duration of surgery, total active motion, intramedullary diameter, pre/postoperative shortening, and pre/postoperative angulation clinically. We used a Method of Shortening Stipulated to measure shortening and the Medullary Canal-lateral view method for angulation. The intramedullary diameter was measured in the mid-shaft of the fifth metacarpal bone in the coronal view. Total active motion was measured at the time of follow-up in our outpatient department.Results: Clinical and radiological parameters showed no statistically significant differences. Even though it did not present a statistical significance, the absolute mean duration of surgery was the shortest in a single K-wire group. Conclusion: The clinical and radiological outcomes of surgery were comparable regardless of the number of K-wires inserted. However, we could look forward to gaining potential benefit from shortened operation time in a single K-wire group. Since stable fixation can be obtained even if one K-wire is used, inserting one thick K-wire into the intramedullary canal can be an alternative according to the surgeon’s preference.

scholarly journals Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

2018 ◽  
Vol 04 (01) ◽  
pp. e29-e33 ◽  
Author(s):  
Jose Couceiro ◽  
Higinio Ayala ◽  
Manuel Sanchez ◽  
Maria De la Red ◽  
Olga Velez ◽  
...  
Keyword(s):  
Return To Work ◽  
Grip Strength ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Active Motion ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Quick Dash ◽  
Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers: reduction and K-wire fixation leaving the metacarpophalangeal and proximal interphalangeal joints free

2011 ◽  
Vol 36 (7) ◽  
pp. 577-583 ◽  
Author(s):  
Mohammad M. Al-Qattan
Keyword(s):  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Industrial Workers ◽  
Active Motion ◽  
Wire Fixation ◽  
Total Active Motion ◽  
K Wires ◽  
Pin Tract Infection ◽  
Transverse Fractures

A series of 35 adult male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were treated with reduction and K-wire fixation leaving the metacarpophalangeal and interphalangeal joints free to move immediately after surgery. At final follow-up, the total active motion score of the injured finger was graded as excellent, good, fair, or poor if it was greater than 240°, 220–240°, 180–219°, or less than 180°, respectively. Complications were also documented. The results were compared with our previously published series of these fractures treated with two other techniques: percutaneous K-wires immobilizing the metacarpophalangeal joint and open reduction and interosseous loop wire fixation. The final TAM scores in the current study were excellent in 43%, good in 29%, fair in 14% and poor in 14%. Four out of the 35 patients (11%) had minor pin tract infection. These results were significantly better than the results following percutaneous K-wire fixation immobilizing the metacarpophalangeal joint indicating that immediate mobilization of all joints has a significant effect on the outcome.

Closed Reduction and Percutaneous Pinning of Fractures of the Proximal Phalanx

2001 ◽  
Vol 26 (1) ◽  
pp. 45-49 ◽  
Author(s):  
E. E. HORNBACH ◽  
M. S. COHEN
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Joint Motion ◽  
Percutaneous Pinning ◽  
Kirschner Wires ◽  
Rotational Deformity ◽  
Active Motion ◽  
Total Active Motion

This study reports the results of 12 unstable extraarticular fractures of the proximal phalanx treated with transarticular intramedullary Kirschner wires. Early proximal interphalangeal joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°. Objective physical assessment revealed one significant flexion contracture, one flexor tendon adhesion and one significant rotational deformity. Excellent results were observed in ten of the 12 patients.

scholarly journals Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 494-499 ◽  
Author(s):  
Michael P. Gaspar ◽  
Shiv D. Gandhi ◽  
Randall W. Culp ◽  
Patrick M. Kane
Keyword(s):  
Grip Strength ◽  
Proximal Phalanx ◽  
Retrospective Chart Review ◽  
Active Motion ◽  
Minimally Invasive Surgical ◽  
Number Of Patients ◽  
Total Active Motion ◽  
Minimally Invasive Surgical Treatment ◽  
Study Inclusion

Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers’ compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.

Clinical Outcomes of Zone 2 Flexor Tendon Repairs Using the Modified Lim/Tsai Technique

2019 ◽  
Vol 24 (01) ◽  
pp. 83-88
Author(s):  
Min Kai Chang ◽  
Sanchalika Acharyya ◽  
Zeus Yiwei Lim ◽  
Shian Chao Tay
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Biomechanical Properties ◽  
Modified Technique ◽  
Active Motion ◽  
Satisfactory Outcome ◽  
Flexor Tendon Injuries ◽  
Total Active Motion

Background: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. Methods: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit. Results: Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration. Conclusions: Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.

Effect of Oral Prednisolone after Collagenase Injection for Dupuytren’s Contracture: A Randomized, Controlled Trial with a 1-Year Follow-Up

2020 ◽  
Author(s):  
Yoshihiro Abe
Keyword(s):  
Controlled Trial ◽  
Oral Prednisolone ◽  
Metacarpophalangeal Joint ◽  
Control Group ◽  
Dupuytren’S Contracture ◽  
Active Motion ◽  
Dupuytren's Contracture ◽  
Significant Difference ◽  
Total Active Motion

Abstract Introduction This study verified the effectiveness of oral prednisolone after collagenase clostridium histolyticum (CCH) (10 mg/day for 2 weeks) for Dupuytren’s contracture with a 1-year follow-up. Materials and Methods This study included 31 patients with a contracture of the metacarpophalangeal joint of ≥ 30 degrees. A total of 16 patients were allocated randomly to treatment with prednisolone and 15 patients were treated without prednisolone (control group). Results At day 7, mean total active motion (TAM) was 235 degrees in the prednisolone group and 228 degrees in the control group. Mean Visual Analog Scale was 3.3 in the prednisolone group and 4.6 in the control group. There was significant difference between two groups. At day 30, mean TAM was 241 degrees in the prednisolone group and 233 degrees in the control group. There were significant difference between two groups The mean QuickDASH score was significantly higher in the control group (5.8 vs. 3.4). Recurrence was observed in 2/16 patients (13%) in the prednisolone group and 5/15 patients (33%) in the control group; there was no significant difference. Conclusion The administration of prednisolone decreased the likelihood of adverse effects, and also improved finger flexion range of motion and reduced pain after CCH.

Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations

2014 ◽  
Vol 40 (3) ◽  
pp. 250-258 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
Y. Maki ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Total Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends ( p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons’ level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV

Flexor Tenosynovectomy and Tenolysis in Longstanding Rheumatoid Arthritis

1996 ◽  
Vol 21 (4) ◽  
pp. 538-543 ◽  
Author(s):  
A. R. TOLAT ◽  
J. K. STANLEY ◽  
R. A. EVANS
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Disease ◽  
Surgical Indications ◽  
Active Motion ◽  
Total Active Motion ◽  
Tendon Ruptures ◽  
Finger Motion ◽  
Digital Surgery ◽  
Low Rate

A total of 43 patients (49 hands; 424 flexor tendons), who had rheumatoid arthritis of more than 15 years duration at the time of surgery, were clinically assessed at a mean follow-up of 5.7 years (range, 1.2–12 years). Pain and inability to flex actively despite a good passive range of motion were the main surgical indications. The results suggest that the patients had excellent sustained pain relief (mean score=0.9) and were highly satisfied with the outcome of the procedure (mean score = 2.2). 81% had adequate pulp-to-pulp and key pinch. Range of finger motion (total active motion, TAM) was excellent to good in 45% and fair in 22%. Thirty-three per cent were graded as poor and these were found to be multifactorial in origin, with associated significant joint disease, preoperative tendon ruptures, extensive digital surgery, readhesions and combinations of operative procedures which adversely affect the rehabilitation programme. Flexor tenosynovectomy with tenolysis is a useful procedure with a low rate of recurrence.

scholarly journals Desarda repair no Mesh and Lichtenstein repair for inguinal hernia (A study of 2793 patients)

2021 ◽  
Vol 3 (9) ◽  
pp. 01-05
Author(s):  
Pedro Rolando Lòpez Rodrìguez ◽  
Eduardo Garcia Castillo ◽  
Olga Caridad Leòn Gonzàlez ◽  
Jorge Agustin Satorre Rocha ◽  
Luis Marrero Quiala ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Operation Time ◽  
Lichtenstein Repair ◽  
Prospective Randomized Controlled Trial ◽  
Duration Of Surgery ◽  
The Mean ◽  
Location Type

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p<0.05).The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair.

scholarly journals Desarda Repair No Mesh and Lichtenstein Repair for Inguinal Hernia a Study of 2793 Patients

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Controlled Trial ◽  
Operation Time ◽  
Lichtenstein Repair ◽  
Prospective Randomized Controlled Trial ◽  
Duration Of Surgery ◽  
The Mean ◽  
Location Type

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p<0.05). The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair

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