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Wu R, Wen Y, Wang C, Liu T, Yu J. Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal-diaphyseal junction fractures of the distal radius: a case-control study. BMC Musculoskelet Disord 2023; 24:922. [PMID: 38037015 PMCID: PMC10688113 DOI: 10.1186/s12891-023-07055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Several methods have been used for the treatment of pediatric distal radius fractures, such as the elastic stable intramedullary nail (ESIN), Kirschner wire (K-wire), and plate, but there has been no consensus about the optimum method. The purpose of this study was to compare ESIN and K-wire techniques used in metaphyseal-diaphyseal junction (MDJ) fractures of the pediatric distal radius. METHODS The data of patients who were treated at a children's hospital affiliated with Shandong University between August 2018 and January 2022 were analyzed retrospectively. The children were divided into the ESIN and K-wire groups. Clinical outcomes were measured by the Gartland and Werley scoring system. Variables were analyzed using a statistical approach between the two groups. RESULTS The study included 26 patients, of whom 11 were treated with K-wire and 15 with ESIN. At the final follow-up, all of the fractures were healed. There were no differences in terms of age, sex, fracture location, or wrist function score. However, the ESIN was superior to K-wire in operative time, fluoroscopic exposure, and estimated blood loss (EBL). CONCLUSIONS K-wire and ESIN are both effective methods in the treatment of MDJ fractures of the pediatric distal radius. The use of the ESIN technique represents less EBL, fluoroscopy exposure, and operation time compared with K-wire. We recommend osteosynthesis by ESIN rather than K-wires in patients with MDJ fractures of the distal radius. LEVEL OF EVIDENCE III, a case-control study.
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Affiliation(s)
- Rongchang Wu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing, 100045, China
| | - Yuwei Wen
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing, 100045, China
| | - Chunhua Wang
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China.
| | - Tao Liu
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China
| | - Jiazhi Yu
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China
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Wasiak M, Piekut M, Ratajczak K, Waśko M. Early complications of percutaneous K-wire fixation in pediatric distal radius fractures-a prospective cohort study. Arch Orthop Trauma Surg 2023; 143:6649-6656. [PMID: 37522939 PMCID: PMC10541837 DOI: 10.1007/s00402-023-04996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Distal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures. MATERIALS AND METHODS One hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien-Dindo-Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites. RESULTS Forty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery-deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common-40 wrists (33,6%). CONCLUSIONS The CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient's postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.
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Affiliation(s)
- Michał Wasiak
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland.
| | - Maciej Piekut
- Department Orthopaedic Surgery and Traumatology, Popiełuszko Memorial Bielański Hospital, Warsaw, Poland
| | - Karol Ratajczak
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
- Department Orthopaedic Surgery and Traumatology, Bogdanowicz Memorial Hospital, Warsaw, Poland
| | - Marcin Waśko
- Department of Radiology and Imaging, Centre of Postgraduate Medical Education, Warsaw, Poland
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Abulsoud MI, Mohammed AS, Elmarghany M, Elgeushy A, Elzahed E, Moawad M, Elshal EA, Elhalawany MF, Hassanein YA, Fouad AA, Zakaria AR. Intramedullary Kirschner wire fixation of displaced distal forearm fractures in children. BMC Musculoskelet Disord 2023; 24:746. [PMID: 37735419 PMCID: PMC10512509 DOI: 10.1186/s12891-023-06875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
AIM OF THE WORK This study was designed to highlight internal fixation by intramedullary K-wires for displaced distal forearm fractures among children and analyze the results of this technique. We hypothesize that physis-sparing intramedullary fixation prevents displacement with a lower complication rate. METHODS This prospective case series involving 47 patients was conducted between February 2018 and December 2019. All patients with open physis presented with recent displaced distal forearm fractures were included, and all of them were treated with an intramedullary k-wire fixation for both bones with the assessment of the union rate, union time, suspected complication, radiographic evaluation, and functional outcome. RESULTS The study population consisted of 31 boys (66%) and 16 girls (34%). The mean age of the patients was 10.68 ± 2.728 years (range, 7-15 years). All fractures were united in a median of 6 weeks (range, 4-8 weeks), The functional outcome after 12 months was normal in 42 patients (89.4%), whereas, in five patients (10.6%), the functional parameters were minimally reduced. The median preoperative angulation improved from 36° (range, 24°-52°) preoperatively to 4° (range, 0°-10°) on immediate postoperative radiographs. After 12 months, the median angulation was 2° (range, 0°-7°) (p < 0.001). The angulation of the distal radius immediately after surgery and at the final follow-up was statistically correlated with the functional outcome (p < 0.001 and 0.002, respectively). CONCLUSION This technique provides a good result with less susceptibility to re-displacement and low complication rates. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mohamed I Abulsoud
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Ahmed Saied Mohammed
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Elmarghany
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elgeushy
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ehab Elzahed
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Moawad
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ehab A Elshal
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed F Elhalawany
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yahia A Hassanein
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amr A Fouad
- Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed R Zakaria
- Department of Orthopedic Surgery, Helwan University, Helwan, Egypt
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De Vitis R, D'Orio M, Passiatore M, Perna A, Cilli V, Taccardo G. Elastic stable intramedullary fixation using epibloc versus crossed kirschner wires fixation for distal forearm fractures in children: A retrospective analysis. Afr J Paediatr Surg 2022; 19:153-159. [PMID: 35775516 PMCID: PMC9290372 DOI: 10.4103/ajps.ajps_178_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device. MATERIALS AND METHODS A retrospective analysis was performed on 44 children (age 6-11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery. RESULTS No differences were observed comparing Group A and B in terms of the maintenance of reduction (P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM (P < 0.05). No differences were revealed in terms of complications between the two groups. CONCLUSION ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.
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Affiliation(s)
- Rocco De Vitis
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco D'Orio
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Passiatore
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Perna
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vitale Cilli
- Hand Surgery Unit, CHIREC Site Delta, Bruxelles, Belgium
| | - Giuseppe Taccardo
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Perna A, Mancino F, Campana V, Satta P, Marcialis V, Glorioso D, Monterossi M, Proietti L, De Santis V. Is it time to resume elective knee arthroplasty surgery? A multidisciplinary experience in a Sardinian center during the SARS-CoV-2 pandemic. Orthop Rev (Pavia) 2022; 14:33768. [PMID: 35774931 PMCID: PMC9239359 DOI: 10.52965/001c.33768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 09/19/2023] Open
Abstract
Background Starting in January 2020, the SARS-CoV-2 pandemic caused changes in the nation's health systems. The hospital's reorganization led to a near-total stop of non-urgent, elective surgeries across all specialties, including hip and knee arthroplasty. However, in May 2020, a gradual elective surgery restarting was possible. Considering the risk of COVID-19 infections, the European Knee Associates suggest the need to implement specific protocols for a safe return to orthopaedic elective surgery. Methods A retrospective analysis regarding all patients who underwent primary knee arthroplasty (TKA) between March 1st and October 1st, 2020 using an institutional database was performed. The study time was divided into 2 periods: Pandemic (from March 2020 to May 2020), Post Pandemic (from June 2020 to October 2020). A specific protocol was designed to safeguard the health of patients and healthcare workers during the SARS-CoV-2 pandemic. Results A total of 147 patients underwent total knee replacement surgery in the analyzed period. The mean surgical time was 77.6 (+/-18.9). The intraoperative mean blood loss was 54 (+/-28) ml. The mean hospital stay was 3-4 days. Among the treated patients no case of COVID-19 infection was observed. Conclusion The use of our protocol, developed ad hoc for the management of elective orthopedic patients, allowed the restart of elective orthopedic surgery in a safe and reproducible way with an average increase of 374% on surgical activity between the pandemic and post-pandemic periods without record cases of contagion among the treated patients.
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Affiliation(s)
- Andrea Perna
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Fabio Mancino
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | | | - Paolo Satta
- Department of Orthopaedics, Mater Olbia Hospital
| | | | - Davide Glorioso
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Martina Monterossi
- Department of Anaesthesiology, Intensive Care Medicine and Toxicology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Luca Proietti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Vincenzo De Santis
- Department of Orthopaedics and Traumatology, Università Cattolica del Sacro Cuore
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Hung WC, Wang JP, Huang YC, Yin CY, Wu CY, Huang HK. Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability. BMC Musculoskelet Disord 2022; 23:158. [PMID: 35177051 PMCID: PMC8851747 DOI: 10.1186/s12891-021-04857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure. Methods Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18–57 years), and the mean duration from injury to operation was 7.8 months (range, 3–25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12–26 months). Results All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities. Conclusions We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.
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Affiliation(s)
- Wei-Chen Hung
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Yu Yin
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan. .,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan.
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Leti Acciaro A, Garagnani L, Lando M, Cataldo G, Adani R. Retrospective study of radial dome osteotomy with volar plate fixation versus K-wires in Madelung's deformity: long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 46:281-289. [PMID: 34850246 DOI: 10.1007/s00264-021-05266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The emerging role of the locking plate improved the technique also in corrective osteotomies in Madelung's deformity, but there is a lack of analyses between the fixation techniques, as well as little information in functional outcomes and long-term follow-up. The current study compared the outcomes, pitfalls, and advantages of volar plate and screws fixation versus K-wires fixation in a long-term follow-up. METHODS Twenty-eight children presenting the "distal radius" variant of Madelung's deformity underwent Vickers ligament release and distal radial dome osteotomy between 2009 and 2015. Twenty-three children (20 females and 3 males, mean age 15 years and 7 months at surgery and 24 years and 8 moths at follow-up), with 26 operatively treated wrists, were available for follow-up. A retrospective two-cohort study, evaluating clinically and radiologically results, has been conducted with a mean eight years and seven months follow-up. RESULTS Bone union and pain relief were obtained in all cases, as well as improvements in wrist motion and radiographic indices. A statistically significant correlation was identified between the volar plate fixation and an improved lunate subsidence on X-ray, and a trend towards an improved DASH score in the cohort with plate and screws, as well as significant improvement in wrist extension and supination always in the plate fixation cohort. CONCLUSIONS The long-term follow-up enabled the patients to report on more definitive outcomes in terms of functional and cosmetic improvements. Volar plate fixation is an effective technique allowing for simple post-operative management and earlier rehabilitation program with improved clinical and radiographic outcomes.
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Affiliation(s)
- Andrea Leti Acciaro
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy.
| | - Lorenzo Garagnani
- Hand Unit/Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mario Lando
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
| | - Giacomo Cataldo
- Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, AOU Policlinico, Modena, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, AOU Policlinico, L.go del Pozzo, 71, 41124, Modena, Italy
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Yan G, Nan G. Modified osteotomy for treatment of forearm deformities (Masada IIb) in hereditary multiple osteochondromas: a retrospective review. BMC Musculoskelet Disord 2021; 22:943. [PMID: 34758801 PMCID: PMC8582216 DOI: 10.1186/s12891-021-04829-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Approximately 30% of patients with hereditary multiple osteochondromas (HMO) have forearm deformity and dysfunction. The aim of this retrospective study was to review our experience with the surgical treatment of children with HMO and Masada IIb forearm deformities. Methods Data of eight children treated for HMO Masada IIb forearm deformity at our hospital between 2015 and 2019 were collected from the hospital records and retrospectively reviewed. All patients underwent ulnar lengthening by distraction osteogenesis using either the Orthofix or Ilizarov external fixator. Range of movements at the elbow and wrist joints, and forearm supination/pronation, before and after the operation were recorded. Radiographs were evaluated by the Fogel method, and wrist joint function by the Krimmer method. Results Follow-up radiographs showed significant improvement in relative ulnar shortening after treatment (pre-operative 9.23 ± 5.21 mm; post-operative 0.33 ± 4.13 mm). Changes in radial articular angle (pre-operative 33.55° ± 3.88° to 32.78° ± 6.57°) and carpal slip (pre-operative 45.00% ± 19.09%; post-operative 43.13% ± 16.68%) were not significant. Elbow flexion and extension, wrist flexion and extension, ulnar and radial deviation at wrist, and forearm rotation were significantly improved after surgery. Wrist function was graded as excellent in seven patients and as good in one patient. One patient treated with the Ilizarov external fixator had poor radial head reduction. Conclusion Ulnar lengthening with distraction osteogenesis is an effective treatment for HMO Masada IIb deformities. The optimum site for ulnar osteotomy appears to be at the proximal one-third to one-fourth of the ulna. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04829-x.
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Affiliation(s)
- Ge Yan
- Department of Orthopaedics Children's Hospital of Chongqing Medical University, China, Yuzhong District Zhongshan 2road 136#, 400014, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Guoxin Nan
- Department of Orthopaedics Children's Hospital of Chongqing Medical University, China, Yuzhong District Zhongshan 2road 136#, 400014, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China. .,China International Science and Technology Cooperation base of Child development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Gui XY, Cheng ZH, Shi HF, Chen YX, Xiong J, Wang JF, Qiu XS, Zhang ZT. Single volar locking plating for the intra- and extra-articular distal radius fractures with dorsal metaphyseal comminution. J Orthop Surg Res 2021; 16:530. [PMID: 34433474 PMCID: PMC8385909 DOI: 10.1186/s13018-021-02641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. MATERIALS AND METHODS Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors' institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. RESULTS A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month's follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. CONCLUSIONS The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. TRIAL REGISTRATION This study has been registered on the ClinicalTrials.gov.
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Affiliation(s)
- Xue-Yang Gui
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zhao-Hui Cheng
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Hong-Fei Shi
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Yi-Xin Chen
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Jun-Fei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Xu-Sheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
| | - Zi-Tao Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China
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Chiu YC, Hsu CE, Ho TY, Ting YN, Tsai MT, Hsu JT. Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone. BMC Musculoskelet Disord 2021; 22:431. [PMID: 33971840 PMCID: PMC8112006 DOI: 10.1186/s12891-021-04276-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure. OBJECTIVE To evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires. MATERIALS AND METHODS We used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force-displacement data. The Mann-Whitney U test was used to compare between-group differences in maximum fracture force and stiffness. RESULTS The maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p < 0.05; Figure 5a), with the median of the KP&F8 group exceeding that of the KP group by 57.5%. Similarly, stiffness was significantly lower in the KP group (18.14 ± 9.84 N/mm) than in the KP&F8 group (38.25 ± 23.49 N/mm; p < 0.05; Figure 5b), with the median of the KP&F8 group exceeding that of the KP group by 110.9%. CONCLUSION The incorporation of a figure-of-eight cerclage wire increased the maximum fracture force and stiffness by 57.5 and 110.9%, respectively, compared with those achieved in standard two K-wire fixation. Therefore, hand surgeons are advised to consider the proposed approach to increase fixation strength.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan, ROC
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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A Single Intramedullary K-Wire Is Sufficient for the Management of Nonthumb Metacarpal Shaft Fractures. Adv Orthop 2021; 2021:9963186. [PMID: 34055414 PMCID: PMC8112946 DOI: 10.1155/2021/9963186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to evaluate the outcome after the internal fixation of diaphyseal metacarpal fractures by a single intramedullary K-wire. Methods In this prospective case series study, conducted from July 2017 to June 2019 in 23 adult patients with a single, unstable, diaphyseal metacarpal fracture, outcomes after internal surgical fixation using a single antegrade intramedullary K-wire were evaluated. The outcomes were evaluated by union rate, time to union, handgrip measurements at 6 and 12 months, and the modified Disabilities of the Arm, Shoulder, and Hand (DASH) score at 12 months. Results The study population consisted of 17 males and 6 females, with a mean patient age of 28.4 ± 8.5 years (range, 16–45 years). The median time to final follow-up was 14 ± 1.8 months (range: 12–24 months). The mean duration of the union was 7.3 ± 1.6 weeks (range: 5–11 weeks), with a union rate of 95.7% (22 cases). The mean handgrip strength was 68% ± 12.8% of the strength of the uninjured hand after 6 months and 92.7% ± 6.9% after 12 months. The mean modified DASH score was 2.6 ± 0.26 after 12 months (range: 0–5.8). There were no cases of malrotation or infection. In conclusion, using a single 1.8–2.0 mm K-wire gives excellent functional outcomes and union rate without significant complications when used to treat an unstable metacarpal shaft fracture.
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Calawerts W, Piggott C, Khodaee M. Non-union ulnar fracture as a result of a remote injury. BMJ Case Rep 2021; 14:e242854. [PMID: 33782078 PMCID: PMC8009219 DOI: 10.1136/bcr-2021-242854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- William Calawerts
- Department of Family Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Cleveland Piggott
- Department of Family Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Morteza Khodaee
- Department of Family Medicine and Orthopedics, University of Colorado Denver School of Medicine, Denver, Colorado, USA
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De Vitis R, Passiatore M, Cilli V, Lazzerini A, Marzella L, Taccardo G. Feasibility of Homodigital Flexor Digitorum Superficialis transposition, a new technique for A2-C1 pulleys reconstruction: A kinematic cadaver study. J Orthop 2020; 21:483-486. [PMID: 32982105 PMCID: PMC7498708 DOI: 10.1016/j.jor.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/06/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Homodigital flexor digitorum superficialis transposition (HFT) is proposed as a new technique for A2-C1 pulley reconstruction. Flexor digitorum superficialis is transposed on the proximal phalanx and inserted on the pulley rims, crossing over flexor digitorum profundus and acting as a pulley. MATERIALS AND METHODS The kinematic feasibility was investigated in a cadaveric bowstring model (after A2 and C1 pulley removal) on 22 fingers (thumb excluded). RESULTS HFT was effective in restoring the correct flexion of proximal and distal interphalangeal joints, compared to bowstring model. No adverse events were registered. CONCLUSION HFT is a feasible technique. Clinical application is encouraged.
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Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
| | - Marco Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica Ortopedica, Italy
| | - Vitale Cilli
- Chirurgie de La Main, CHIREC Site Delta, Bruxelles, Belgium
| | | | | | - Giuseppe Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
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