scholarly journals Cannulated screw versus Kirschner-wire fixation for Milch II lateral condyle fractures in a paediatric sawbone model: a biomechanical comparison

2018 ◽  
Vol 12 (1) ◽  
pp. 29-35 ◽  
Author(s):  
D. Franks ◽  
J. Shatrov ◽  
M. Symes ◽  
D. G. Little ◽  
T. L. Cheng
Keyword(s):  
Screw Fixation ◽  
Cannulated Screw ◽  
Screw Placement ◽  
Lateral Condyle ◽  
Rigid Fixation ◽  
Cannulated Screws ◽  
Lateral Column ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
K Wires

Purpose Lateral condyle fractures of the humerus are common in the paediatric population, accounting for up to 20% of elbow fractures. Traditional management involves internal fixation with Kirschner (K)-wires, however, this has been associated with complications and insufficiently rigid fixation. Recently, cannulated screws have been proposed as a more stable method of fixation. While cannulated screws have been thought to allow earlier range of movement and shorten time to union, data regarding the biomechanical performance and optimal screw placement is scarce. We hypothesize that cannulated screw fixation is superior to K-wire fixation and screw placement can enhance the stability of the construct. Methods Paediatric humerus sawbones with Milch II fractures were fixed with one of three methods. Fractures were reduced with either a single cannulated screw either through the centre of the capitellum (oblique), or placed up the lateral column across the growth plate (lateral), or fixed with two K-wires. Fixed sawbone fractures were then mechanically tested in two directions simulating in vivo forces. Results The lateral screw construct had a higher maximum force to failure, higher stiffness and absorbed higher energy as compared with the K-wire fixation and oblique screw under an anterior force. When loaded from the posterior direction, only the lateral column screw was better than K-wire fixation. Conclusions Screw fixation is a biomechanically effective alternative to K-wire fixation, especially when placed up the lateral column of the distal humerus. Further clinical studies are required before transcapitellar screw fixation can be adopted.

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.

scholarly journals Buried or unburied K-wires for lateral condyle elbow fractures

2012 ◽  
Vol 94 (7) ◽  
pp. 513-516 ◽  
Author(s):  
L McGonagle ◽  
S Elamin ◽  
DM Wright
Keyword(s):  
Deep Infection ◽  
Lateral Condyle ◽  
Non Union ◽  
Increased Risk ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
Superficial Wound ◽  
Fracture Configuration ◽  
K Wires ◽  
Humeral Condyle

INTRODUCTION Lateral humeral condyle fractures typically require a longer period of internal fixation than other distal humeral fractures due to the increased risk of non-union. K-wires can be buried and left in situ until union or they can be left unburied and require removal after four weeks, with plaster immobilisation until union. There is no consensus as to whether wire burial is preferable or not. The aim of this study was to determine whether K-wire burial is associated with more complications than non-buried wires in treating lateral condyle fractures of the elbow. METHODS All patients with lateral humeral condyle fractures treated with K-wire fixation at our institution from May 2008 to August 2011 were included in the study. Fracture configuration, mode of reduction, wire burial and complications were assessed. RESULTS Sixty-seven patients (19 girls and 48 boys, mean age: 6.5 years, range: 1–17 years) were included in the study. All had closed injuries and were treated with open reduction and K-wire fixation. K-wires were buried in 55 patients. Thirteen cases of buried wires eroded through skin and were removed on average 45 days (range: 30–58 days) post-operatively. Of the wire erosion cases, three developed microbiologically proven infections, one of which was a deep infection. There were a further three superficial wound infections in the absence of wire erosion through the skin. There were complications in 2 of the 12 cases in the unburied wires group: 1 microbiologically proven superficial wire site infection and 1 wire backed out after 11 days, requiring refixation. CONCLUSIONS Wire erosion through the skin is the most common complication of K-wire burial. This may be due to the decrease in swelling after fracture fixation, making the wires more prominent under the skin. Skin integrity should be monitored closely if wires are buried.

Cannulated screws for odontoid screw fixation and atlantoaxial transarticular screw fixation

1995 ◽  
Vol 83 (6) ◽  
pp. 1095-1100 ◽  
Author(s):  
Curtis A. Dickman ◽  
Kevin T. Foley ◽  
Volker K. H. Sonntag ◽  
Maurice M. Smith
Keyword(s):  
Cervical Spine ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Atlantoaxial Instability ◽  
Cannulated Screws ◽  
Content Type ◽  
Screw Insertion ◽  
Bone Fragments ◽  
K Wires ◽  
Fine Print

✓ Cannulated screw systems use thin Kirschner wires (K-wires) that have been drilled into the bone to direct screw trajectories accurately into small bone fragments. Use of the K-wires avoids overdrilling the pilot holes and allows fixation of adjacent bone fragments during screw insertion. Hollow tools and hollow screws are inserted into the bone over the K-wires. Cannulated screw fixation is useful in the cervical spine to stabilize odontoid fractures and to treat atlantoaxial instability. This report describes techniques for successful cannulated screw insertion and methods to minimize complications. Cannulated screws have several distinct advantages compared to noncannulated screws: 1) the K-wires guide the screw position into the bone; 2) the K-wire trajectory can be repositioned easily if the original trajectory was not ideal; 3) the K-wires allow continuous fixation of adjacent unstable bone fragments; and 4) the K-wires prevent migration of unstable bone fragments during screw insertion. Complications associated with the K-wire (breakage, repositioning, and advancement) can be minimized using precise operative techniques, a specialized tool system, and intraoperative fluoroscopic monitoring. A unique cannulated screw tool system was developed specifically for upper cervical fixation to allow percutaneous drilling using long tunneling devices, tissue sheaths, drill guides, and long K-wires. These tools allow delivery of cannulated fracture-fixation screws at a low angle to the spine through long soft-tissue trajectories. Cannulated screws have significant advantages compared to noncannulated screws for fixation of the unstable cervical spine.

scholarly journals Assessment of First Metatarsal Head Bone Density for Optimal Screw Placement in Minimally-Invasive Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Katherine M. Dederer ◽  
Patrick J. Maloney ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Rebecca A. Cerrato
Keyword(s):  
Bone Density ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Screw Placement ◽  
Cannulated Screws ◽  
First Metatarsal ◽  
History Of

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Minimally-invasive surgery (MIS) for hallux valgus correction has become increasingly common. This technique involves an osteotomy of the first metatarsal, followed by fixation with two cannulated screws. Since screws are typically not bicortical, they rely upon bone quality within the metatarsal head for fixation strength. However, bone mineral density (BMD) within different regions of the metatarsal head is unknown. Measuring the BMD in the target region may predict the strength of the bone-screw fixation. Similar to previous work which determined the optimal position for lag screw placement in the femoral head during hip fracture fixation, this study aimed to determine average BMD within four quadrants of the metatarsal head using CT and thus predict the optimal trajectories for cannulated screws during the MIS bunion procedure. Methods: All patients between 18-75 years of age scheduled to undergo MIS hallux valgus correction by one of two surgeons experienced in the MIS technique were eligible to participate. Patients were excluded if they had a prior first metatarsal surgery, pre-existing hardware, previous first metatarsal fracture, or a history of osteoporosis treatment. Patients were enrolled prospectively, and a weight-bearing CT scan of the affected foot was obtained pre-operatively. Demographic factors including age, sex, laterality, body mass index (BMI), comorbidities, and smoking status as well as standard three-view weight-bearing radiographs were collected for all patients.Using the coronal CT slice at maximal metatarsal head diameter, each head was divided into equal quadrants. Hounsfield units (HU) within each quadrant were measured independently by three study investigators using our hospital’s radiology viewing software (Merge PACS; IBM Corporation, Armonk, NY), and these density measurements were averaged. Statistical analysis was conducted using ANOVA and Student’s t-test. Results: Fifteen patients were included for preliminary analysis. All patients were female. The average age was 45.7 years. 9 of the 15 included feet were right feet. Average BMI was 28.0. One patient reported active smoking prior to surgery. Comorbidities included obesity in three patients; none were diabetic. One had a history of diplegic cerebral palsy. The average HVA on a weight- bearing AP foot x-ray was 28.2°, and the average IMA was 12.6°. The BMD within the metatarsal head varied by quadrant, with the two combined dorsal quadrants having higher average BMD than the two combined plantar quadrants (122 vs 85 HU; p<0.001). The dorsal lateral quadrant had the highest average BMD of any quadrant (132 HU, p<0.001; Table 1). Conclusion: The density of the metatarsal head did vary by region within the head. The highest BMD was found in the dorsal lateral quadrant, and the lowest in the plantar lateral and plantar medial quadrants, which did not differ significantly from each other. Because strength of screw fixation is predicated upon screw design as well as bone density, these results suggest that surgeons may wish to direct screws toward the dorsolateral region of the metatarsal head in order to achieve optimal fixation. Further work is needed to determine whether this varies with patient age, gender, or hallux valgus angle. [Table: see text]

scholarly journals Study of Supracondylar Fracture of Distal Humerus in Children and Its Management with Lateral K-Wire Fixation

2014 ◽  
Vol 3 (1) ◽  
pp. 38-43
Author(s):  
K Sapkota ◽  
B Shrestha
Keyword(s):  
Excellent Result ◽  
Distal Humerus ◽  
Supracondylar Fracture ◽  
P Value ◽  
Lateral Column ◽  
Fractures In Children ◽  
Significant Difference ◽  
Wire Fixation ◽  
Carrying Angle ◽  
K Wires

Background: Supracondylar fracture is one of the common fractures in children. There are different methods of treatment. This study was undertaken to evaluate the results of lateral k wire fixation for the displaced supracondylar fracture of distal humerus in children. Methods: There were 32 children with displaced Supracondylar fracture, treated with closed reduction and percutaneous lateral K-wires fixation. Clinical and radiological assessments were done and outcomes were assessed on basis of Flynn criteria and data were analyzed in SPSS 16. P value <0.05 was considered significant. Result: The mean age of patients was 6.41 ± 2.37 with boys predominant. There were excellent result of 24(75%) good result 5(15%) regarding carrying angle and regarding range of motion 25 (78%) excellent and4(12%) good result. There were more than 90% patients with excellent to good result. Comparing the Baumann’s angle intra-operatively and at the final follow up, there was no statistically significant difference with P value > 0.05. Conclusion: Lateral pinning with 2 and if necessary 3 k wires for proper stabilization and idea configuration of divergent to hold medial and lateral column is the ideal treatment of supracondylar fracture without risk of iatrogenic nerve injury. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 38-43 DOI: http://dx.doi.org/10.3126/njms.v3i1.10356

scholarly journals Experimental Analysis of Strength Characteristics of Devices for Acetabular Osteosynthesis

2015 ◽  
pp. 91-94
Author(s):  
E. I. Solod ◽  
A. F. Lazarev ◽  
N. S. Gavryushenko ◽  
L. V. Fomin ◽  
I. N. Sakharnykh ◽  
...  
Keyword(s):  
Experimental Analysis ◽  
Testing Machine ◽  
Cannulated Screw ◽  
Acetabular Fractures ◽  
Rigid Fixation ◽  
Transverse Fracture ◽  
Cannulated Screws ◽  
Stable Fixation ◽  
Comparative Testing ◽  
Universal Testing

Three common elementary acetabular fractures, i.e. transverse fracture, fractures of anterior and posterior column, were simulated on plastic pelvis models. Comparative testing of three types of osteosynthesis - with reconstructive plate, cannulated screws and pins or using our new CITO flattened fine thread screws 3 mm in diameter were performed under similar conditions. Strength of cannulated screw and CITO screw was evaluated. Testing was performed on servo-hydraulic universal testing machine. The most stable fixation was achieved with cannulated screw and CITO screw. The latter was inferior in strength however ensured required rigid fixation.

scholarly journals Lateral condyle elbow fractures: Buried versus unburied K-wires

2013 ◽  
Vol 11 (8) ◽  
pp. 711
Author(s):  
Salma E. Elamin ◽  
Lorcan McGonagle ◽  
David Wright
Keyword(s):  
Lateral Condyle ◽  
Elbow Fractures ◽  
K Wires

scholarly journals Fractures of the Zygomaticomaxillary Complex and Their Treatment: A Case Report

2016 ◽  
Vol 20 (1) ◽  
pp. 40-43
Author(s):  
Esat Bardhoshi
Keyword(s):  
Case Report ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Rigid Fixation ◽  
Facial Fractures ◽  
Titanium Plate ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Wire Osteosynthesis ◽  
Zygomaticomaxillary Complex

SummaryFractures of the zygomaticomaxillary complex are the second most common of all facial fractures. Several fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial Kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating system. Internal fixation with titanium plates and screw provides the most rigid fixation and thus greater immobility of the fracture segments. The degree of immobilization created with titanium plates and screws also allows fixation at fewer anatomic points.

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