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.

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 Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

2020 ◽  
Vol 7 (1) ◽  
pp. 78
Author(s):  
Nitin Choudhary ◽  
Sanjeev Gupta ◽  
Neeraj Mahajan ◽  
Rahul Mahajan ◽  
Amar Saharan
Keyword(s):  
Exposed Group ◽  
Lateral Condyle ◽  
Risk Of Infection ◽  
Union Rate ◽  
Kirschner Wires ◽  
Major Procedure ◽  
Carrying Angle ◽  
K Wires ◽  
A Prospective Study ◽  
Humeral Condyle

<p><strong>Background:</strong> Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.</p><p><strong>Methods:</strong> A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020.  A total number of 37 subjects were included in the study.</p><p><strong>Results:</strong> Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.</p><p><strong>Conclusions: </strong>Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort.</p>

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 Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?

2021 ◽  
Author(s):  
Michalis Panteli ◽  
James Shen Hwa Vun ◽  
Robert Michael West ◽  
Anthony John Howard ◽  
Ippokratis Pountos ◽  
...  
Keyword(s):  
Open Reduction ◽  
Femoral Fractures ◽  
Deep Infection ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Non Union ◽  
Cerclage Wire ◽  
Femur Fractures ◽  
Increased Risk

Abstract Purpose The aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union. Methods All consecutive patients with a fracture involving the subtrochanteric region were retrospectively identified, over an 8-year period. Data documented and analysed included patient demographics, fracture characteristics, patient comorbidities, time to fracture union and development of complications. Results A total of 512 patients met the inclusion criteria (523 fractures). Open reduction was performed in 48% (247) of the fractures. Following matching and regression analysis, we identified diaphyseal extension of the fracture to be associated with an open reduction (OR: 2.30; 95% CI 1.45–3.65; p < 0.001). Open reduction was also associated with an increased risk of superficial infection (OR: 7.88; 95% CI 1.63–38.16; p = 0.010), transfusion within 48 h following surgery (OR: 2.44; 95% CI 1.96–4.87; p < 0.001) and a prolonged surgical time (OR: 3.09; 95% CI 1.96–4.87; p < 0.001). The risk of non-union, deep infection and overall mortality was not increased with open reduction. The use of cerclage wires [50 out of 201 fractures (24.9%) treated with an open reduction] to achieve anatomical reduction as compared to open reduction alone significantly reduced the risk of non-union (OR: 0.20; 95% CI 0.06–0.74; p = 0.015). Conclusion Open reduction of subtrochanteric fractures is not associated with an increased risk of deep infection and non-union, even though it is associated with an increased risk of superficial infection, prolonged surgical time and transfusion. The use of cerclage wire is associated with reduced risk of non-union with little evidence of an increase in complications. Level of evidence III.

scholarly journals Open reduction and K-wires fixation of medial humeral epicondyle fractures with intra-articular elbow entrapment in children

2020 ◽  
Vol 8 (1) ◽  
pp. 73-82
Author(s):  
Daniele Massetti ◽  
Mario Marinelli ◽  
Valentino Coppa ◽  
Danya Falcioni ◽  
Nicola Specchia ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Upper Limb ◽  
Open Reduction ◽  
Medial Epicondyle ◽  
Oral Antibiotic ◽  
Radiographic Outcomes ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
The Mean ◽  
K Wires

Background. Medial epicondyle fracture (MEF) is a common injury of all elbow fractures in the pediatric and adolescent population and is often associated with elbow dislocation. Traditional management by cast immobilization increasingly is being replaced with early open reduction and K-wires or screws fixation. A consensus about the correct treatment of MEF is currently lacking in the medical literature. The aim of this study was to report the clinical and radiographic outcomes and the complications of patients affected from MEF with intra-articular fragment incarceration treated by open reduction and K-wire fixation. Materials and methods. Thirteen children (aged 813 years) with medial epicondyle fractures (MEF) with intra-articular elbow entrapment were retrospectively reviewed. All the enrolled patients were surgically treated with open reduction and k-wire fixation without exploration of ulnar nerve. Clinical outcomes were evaluated using upper limb alignment in the frontal plane, elbow range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and with the Visual Analogue Scale (VAS). Radiographic outcomes and complications were also evaluated. Results. At a mean follow-up of 24.1 months no patients showed axial deformity of the upper limb or instability of the elbow and with preserved elbow ROM. The mean MEPS was 98.8 and the mean value of the VAS score was 1. The final X-rays showed fracture healing in 11 patients while 2 (15.3%) reported asymptomatic nonunion. Six patients of 13 presented with preoperative paresthesia in the ulnar nerve field but all of them reported a complete recovery after a mean of 4.3 months. All patients returned to their sporting activities at a mean of 5.4 months after surgery. One patient (7.7%) reported a superficial surgical wound infection treated with oral antibiotic medication without further surgery. No other complication was found. Conclusions. The results demonstrate that open reduction and K-wires fixation without exploration of ulnar nerve for MEF with intra-articular elbow entrapment treatment is a safe and effective procedure.

scholarly journals OPEN REDUCTION AND K-WIRE FIXATION OF DISPLACED UNSTABLE LATERAL CONDYLE FRACTURES OF THE HUMERUS IN CHILDREN

2011 ◽  
Vol 18 (03) ◽  
pp. 501-509
Author(s):  
NOOR AKBAR SIAL ◽  
MUHAMMAD JAVAID IQBAL ◽  
MUHAMMAD KALEEM SHAUKAT
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Late Presentation ◽  
Lateral Condyle ◽  
Post Injury ◽  
Medical College ◽  
Fractures In Children ◽  
Pin Fixation ◽  
Wire Fixation ◽  
K Wires

Background: Lateral condyle fractures in children are the second most common fracture about the elbow. The problem arises in those cases which are difficult to treat by pop cast or by close reduction with percutaneous pin fixation. Late presentation is another challenge. We selected surgical treatment for such cases up to 12 weeks to evaluate our results. Objective: To study the usefulness of open reduction and K-wire fixation of displaced, unstable with or without rotation of fractures lateral condyle of the humerus in children presenting up to 12 weeks post injury Design: Prospective. Setting: Three teaching orthopaedic units Independent Medical College / Punjab Medical College, and University Medical College Faisalabad. Period: From January 2008 to December 2010. Method: In this prospective study a series of 22 patients were treated using technique of open reduction and internal fixation with k-wires. The results were assessed by criteria of Agarwal et al with little modification after follow-up for 1 year. Results: Excellent to good results were observed in all the12 patients presenting at 1–4 weeks post injury. In 5 patients presenting at 5–8 weeks, the results were excellent in one, good in 2, fair in1 and poor in one patient. In 5 patients presenting at 9-12 weeks good in 1 fair in 2 and poor in 2 patients. Conclusions: Open reduction and internal fixation is an effective treatment in all cases of displaced fractures of the lateral condyle of the humerus presenting up to 12 weeks post injury on the basis of low surgical complications and high union rate.

scholarly journals Comparison of radiological and clinical outcome among Kirschner wires versus 3.5 mm diameter cannulated cancellous screw internal fixation in treatment for the displaced lateral humeral condyle fractures in children

2021 ◽  
Vol 7 (2) ◽  
pp. 219
Author(s):  
Lokpal Singh Bhati ◽  
Ashish Kumar Gupta ◽  
Jitendra Singh Rathor ◽  
Devendra Singh Rathore ◽  
Deepak Kundu
Keyword(s):  
Screw Fixation ◽  
Lateral Condyle ◽  
Cancellous Screw ◽  
Kirschner Wires ◽  
Fractures In Children ◽  
High Incidence ◽  
K Wires ◽  
Condyle Fracture ◽  
Humeral Condyle ◽  
Written Informed Consent

<p><strong>Background:</strong> Lateral humeral condyle fracture, the second most common injury around the elbow, accounts for 10-20% of all fractures of the elbow in children with a high incidence between two and 14 years.</p><p><strong>Methods:</strong> This hospital based prospective randomized comparative study design was include patients of both sexes in age group of 2 to 14 years attending SMS hospital, Jaipur during April 2018 to June 2019 or till the sample size achieved, with due permission from the institutional ethic committee and review board and after taking written informed consent from the patient.</p><p><strong>Results:</strong> 40 patients out of 50 were grouped as excellent (70.1%) while 13 were found good (22.8%) and only four patients were found poor (7.01%) as per Hardacre criteria of assessment of lateral condyle treatment in k wire group while excellent, good and poor results were found 68.4, 24.5 and 7.01% respectively in CC screw groups</p><p><strong>Conclusions:</strong> The displaced fractures (displacement over 2 mm) can be treated successfully by open reduction and K-wires or screw fixation with excellent results.</p><p> </p>

scholarly journals Comparison of Kirschner wires and Cannulated screw internal fixation for displaced lateral humeral condyle fracture in children

2019 ◽  
Vol 10 (6) ◽  
pp. 75-79
Author(s):  
Pabin Thapa ◽  
Krishna Sapkota ◽  
Krishna Wahegaonkar ◽  
Niraj Ranjeet ◽  
Pratyenta Raj Onta ◽  
...  
Keyword(s):  
Internal Fixation ◽  
P Value ◽  
Lateral Condyle ◽  
Kirschner Wires ◽  
Lateral Condyle Fracture ◽  
The Mean ◽  
K Wires ◽  
Condyle Fracture ◽  
Humeral Condyle ◽  
Screw Group

Background: Lateral condyle fracture of the distal humerus is the second most common injury around the elbow. Aims and Objective: The purpose of the study was to compare Kirschner wires (K-wire) and Cannulated cancellous (CC) screw for internal fixation of displaced lateral humeral condyle fracture in children. Materials and Methods: Forty-six patients with a displaced lateral condyle fracture of humerus were included in the study. Patients were treated with open reduction and internal fixation either with two 1.8mm K-wires or one 4mm CC screw. Fractures were classified according to Milch classification and clinical outcomes were evaluated according to criteria of Hardacre et al. Results: There were 23 patients in each group with the mean age of 6.57 years (range 2 to 12 years). Milch type II was common (n= 34) than Milch type I (n=12). Fracture union was observed at mean 4.13 weeks in the CC screw and 4.61 weeks in K-wire group.(p value = 0.026). On an average the CC screws were removed at 13.57 weeks and K-wires were at 4.57 weeks. The mean follow-up was 13.83 months in CC screw and 12.52 months K-wire group. Three patients (6.5%) had superficial pin site infection and 2 patient (4.3%) had lateral condyle prominence in the K-wire group and only one lateral condyle prominence (2.2%) was observed in the CC screw group. According to the Hardacre et.al criteria CC screw group were excellent in 20 (87%) and good in 3 (13%) patients whereas 13 (56.5%) excellent and 10 (43.5%) good results were found in the K-wire group. (p value = 0.022). Conclusion: Open reduction and internal fixation with either K-wires or cannulated cancellous screw for displaced lateral condyle fracture of humerus are both effective treatment methods but screw fixation provides absolute stability at the fracture site enhancing the fracture healing, reduces the probability of lateral prominence and allows early range of motion and activity in the affected elbow.

Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation

2014 ◽  
Vol 40 (4) ◽  
pp. 351-355 ◽  
Author(s):  
H. P. Singh ◽  
C. Hoare ◽  
N. Beresford-Cleary ◽  
R. Anakwe ◽  
M. Hayton
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Senior Author ◽  
Union Rate ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Wire Fixation ◽  
Headless Compression Screws ◽  
K Wires

We reviewed 63 trapeziometacarpal arthrodeses (57 patients) performed in our unit between April 2007 and May 2013 for osteoarthritis. K-wires, plates, headless compression screws and memory staples were used for fixation. The average age of patients was 50 (range 20–78) years and there were 36 men and 21 women with a mean follow-up of 36 (range 6–62) months. K-wires were used in 31 cases, staples in 12, plates in five, and screws in 15 joints. The overall non-union rate was 11%, however, when using K-wires for fixation, it was 20%. Union was achieved in all cases when staples or screws were used for fixation. Disabilities of the Arm, Shoulder and Hand scores were higher in cases where non-union occurred compared with those that united (66.7 vs. 21.9). Trapeziometacarpal arthrodesis for osteoarthritis gives good clinical outcome with lower (DASH) scores when union occurs. K-wire fixation led to a 20% non-union rate, and as a result, the senior author no longer uses this method of fixation.

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