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2022 ◽  
Vol 19 (1) ◽  
pp. 59-63
Author(s):  
Sabin Shrestha ◽  
Dinesh Kumar Shrestha

Introduction: Monteggia fracture dislocations are rare injuries (<5%) where missed treatment results into deformity and dysfunction of forearm and hand. For the better functional result early diagnosis, accurate reduction of radial head and rigid fixation of ulna and immobilization during post-operative period for ligamentous healing around radius is vital. So operative treatment has been the primary method of treatment to prevent deformity and disability in monteggia fracture dislocation. Aims: The aim of this study was to evaluate the time taken to unite fractures, complications encountered and assess the functional outcome on the basis of K-wire fixation in monteggia fracture dislocation in children. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke with monteggia fracture dislocation in children. Results: Thirty-two monteggia fracture dislocation in children between six to 14 years of age were treated with intramedullary K-wires after reduction of radial head. Seven cases had open reduction, and five needed trans-capitellar K-wire supplementation. Mean union time was 8.44±1.94 weeks ranging from seven to 12 weeks. The functional outcome on the basis of Anderson’s scoring system was excellent in 25(78.1%), good in three and optimal in four cases. Conclusion: Monteggia fracture dislocation is better treated early and early mobilization of elbow joint is needed for better functional results.


2022 ◽  
pp. 175319342110676
Author(s):  
Alastair Kiszely ◽  
Grey Giddins

During hand surgery, tendons may be at risk of damage. This biomechanical study aims to assess the risk of tendon rupture due to passage of Kirschner wires or hypodermic needles. Porcine extensor tendons were divided into four groups. Group 1: a control group was tested to ensure that repeated stress alone did not cause failure. Group 2a: 1.1-mm Kirschner wires were hand pushed through tendons 50 times and then stressed to 40 N, repeated until tendon failure. In Group 2b, K-wires were passed while rotating using a drill. Group 3: the experiment was repeated using a 20 G hypodermic needle. Group 2a tendons required a median of 2450 passes (1150–3500) to propagate failure, Group 2b a median of 2250 (1200–3850) and Group 3a median of 200 passes (150–450). The risk of tendon rupture from wires or hypodermic needles in procedures appears very low.


2022 ◽  
Vol 86 (1) ◽  
pp. 420-426
Author(s):  
Usama Fawzy Attia ◽  
Mohamed El Soufy ◽  
Tarek ElHewala ◽  
Mohamed Adel Abdelrazek

2022 ◽  
Vol 7 (1) ◽  
pp. 49-58
Author(s):  
Michael Millrose ◽  
Markus Gesslein ◽  
Till Ittermann ◽  
Simon Kim ◽  
Hans-Christoph Vonderlind ◽  
...  

Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results. Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies. A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring. All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.


Hand ◽  
2021 ◽  
pp. 155894472110573
Author(s):  
Dann Laudermilch ◽  
Alejandro Morales-Restrepo ◽  
Sumail Bhogal ◽  
Robert A. Kaufmann

Background: Scaphoid excision 4-corner fusion is a motion-sparing procedure in patients with advanced radioscaphoid arthritis. This study introduces an alternate technique for scaphoid excision 4-corner fusion using a parallel Kirschner wire (K-wire) construct across the midcarpal joints that leads to reliable fusion rates, and good patient outcomes. Methods: This is a single-surgeon, retrospective study of patients who underwent scaphoid excision 4-corner fusion, using a parallel K-wire construct across the midcarpal joints. Once fusion was achieved, K-wires were removed. Radiographic union rate, time to union, capitolunate angle, capitolunate coverage, and amount of midcarpal settling are measured. Patient-reported outcome measures and descriptive statistics are presented. Results: Sixty-five wrists were included in this study with a mean age of 50.1 years. One patient was lost to follow-up. All 64 wrists (100%) fused at an average of 2.6 months. The mean capitolunate angle was 7°, and capitolunate coverage was 99.2%. Fifty-two patients (81%) had adequate radiographs for measurement. Average midcarpal settling was 1.1 mm. Thirty-two patients (51%) were available for long-term follow-up at an average of 5.3 years (0.7-10.2 years), and participated in patient reported outcomes (PRO) surveys. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 16.6, and numeric pain rating scale score was 1.8. Conclusions: Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. Midcarpal settling that occurs through dynamic compression around the K-wires may have contributed to bony fusion. This technique may provide an alternative approach to achieving reliable fusion across the midcarpal joints.


2021 ◽  
Vol 9 (4) ◽  
pp. 471-476
Author(s):  
Patrícia Wircker ◽  
Teresa Alves da Silva ◽  
Rafael Dias

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.


2021 ◽  
Author(s):  
Marcell Varga

Abstract BackgroundDistal radius fractures are very common in paediatric patients. Severely displaced fractures may require surgical intervention. The gold standard surgical method is percutaneous K-wire osteosynthesis followed by immobilisation. Metal implants can be removed with a second intervention; however, these extra procedures can cause further complications. Several studies confirm the benefits of bioabsorbable implants for paediatric patients. The aim of this retrospective study was to compare the complication rates of displaced distal metaphyseal radius and forearm fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.MethodsWe retrospectively reviewed 94 patients in three paediatric trauma centres who underwent operations due to severely displaced distal forearm or metaphyseal radial fractures between January 2019 and January 2020. The mean age was 8.23 (ranging from 5-12). 30 patients (bioresorbable group, BR-group) were treated with biodegradable PLGA implants (Bioretec®, ActivaPin®), 40 patients with one or two stainless steel Kirschner-wires (K-wires, Sanatmetal®) which were buried under the skin (KW I-group) and 30 children with K-wires left outside the skin. (KWII. Group). We examined the number of minor and major complications as well as the need for repeated interventions. Follow-up was at least one year.ResultsThere was no significant difference between the complication rates at the two KW groups (p = 0.241; Cramer’s V = 0.211), while the complication rate of the BR group was significantly lower. (p = 0.049; Cramer’s V = 0.293 and p = 0.002; Cramer’s V = 0.418 respectively). No later than half a year after the injury, no difference was observed between the functional outcomes of the patients in each group. One and a half years after the injury, no signs of growth disturbance were found in any of the children. No second surgical intervention was required in the BR group.ConclusionsSurgeries with bioresorbable intramedullary implants may have fewer complications than K- wire osteosynthesis in the treatment of severely displaced distal forearm fractures. The benefits are most pronounced in the first six weeks after surgery, reducing the number of outpatient visits and increasing the child's sense of comfort. As no second intervention is required, this can lead to significant cost savings. After half a year, there is no difference in the outcomes between the different surgical treatment strategies.


2021 ◽  
Vol 15 (11) ◽  
pp. 3333-3336
Author(s):  
Farhan Majeed ◽  
Maham Ashraf ◽  
Mohsin Tahir ◽  
Ahmad Shams ◽  
Mumtaz Hussain

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation


Author(s):  
Amit Kumar ◽  
Sanjeev Gupta ◽  
Vinay Badyal

Background: Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents, fall, and assault. The main goal of treatment is to achieve the strong bony union without any functional disability. Aim of the study was evaluation of functional outcome of metacarpal fractures managed by operative techniques and to compare the efficacy of different operative techniques.Methods: A total of 50 patients managed by various operative techniques by using k-wires, screws and plates. Functional outcome was assessed by using total active movement (TAM) and disabilities of the arm, shoulder and hand (DASH) scoring system at 6th week, 3rd month and at 6th month.Results: A total 47 fractures united and three fractures mal-united at the time of final assessment. Overall excellent and good results were achieved in 94% cases.Conclusions: Our finding suggests that open reduction and internal fixation with k-wire is most preferable method among all other operative techniques.


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