A review of K-wire related complications in the emergency management of paediatric upper extremity trauma

The biomechanical evaluation of metacarpal fractures fixation methods during finger movements: a finite element study

Objective

This study used finite element analysis to simulate four commonly used fixation methods for metacarpal shaft oblique fractures during finger motion and evaluate their biomechanical performance. The aim was to provide evidence for clinically selecting the optimal fixation method, guiding early rehabilitation treatment, and reducing the risk of complications.

Methods

Finite element analysis simulated dynamic proximal phalanx motion (60° flexion, 20° extension, 20° adduction, and 20° abduction). We analysed stress, displacement, and distributions for dorsal plates, intramedullary nails, Kirschner wire, and screw fixation methods.

Results

At 60° of finger flexion and 20° of abduction, plate fixation demonstrated greater stability and minimal displacement, with a peak displacement of 0.19 mm; however, it showed higher stress levels in all motion states, increasing the risk of failure. The stability of the intramedullary nail was similar to that of the dorsal plate, with a maximum displacement difference of 0.04 mm, and it performed better than the dorsal plate during adduction of 20°. Kirschner wire showed the highest stress levels of 81.6 Mpa during finger flexion of 60°, indicating a greater risk of failure and unstable displacement. Screws had lower stress levels in all finger motion states, reducing the risk of failure, but had poorer stability. Stress and displacement distributions showed that the dorsal plate, intramedullary nail, and Kirschner wire mainly bore stress on the implants, concentrating near the fracture line and the proximal metacarpal. In contrast, the screws partially bore stress in the screw group. The anterior end of the metacarpal mainly hosted the maximum displacement.

Conclusion

This study demonstrates that under simulated finger motion states, the dorsal plate fixation method provides the best stability in most cases, especially during finger flexion and abduction. However, high stress levels also indicate a higher risk of failure. The intramedullary nail is similar to the dorsal plate in stability and performs better in certain motion states. Kirschner wire exhibits the highest risk of failure during flexion. Although screws have poorer stability in some motion states, they offer a lower risk of failure. These findings provide important reference and surgical selection strategies for treating metacarpal fractures.

Antibiotic prophylaxis in surgery for closed fracture of the hand

PURPOSE

Preoperative antibiotic prophylaxis is associated to internal fixation for closed phalangeal and metacarpal fracture, but its effectiveness is not known.

METHODS

In a consecutive series of 119 adult patients undergoing Kirschner-wire fixation for phalangeal or metacarpal fracture, 56.3% (n = 67) received antibiotic prophylaxis and 43.7% (n = 52) did not.

RESULTS

The rate of deep surgical site infection was 1.5% (n = 1) in the group with antibiotic prophylaxis and 1.9% (n = 1) in the group without. Minor skin irritation or infection of the pin tract occurred in 13.4% of cases (n = 9) in the group with antibiotic prophylaxis and 9.6% (n = 5) in the group without.

CONCLUSION

Our findings suggest that use of antibiotic prophylaxis could be reduced in the treatment of closed fractures of the hand treated with removable pins.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV (retrospective review).

Surgical navigation for guidewire placement from intraoperative fluoroscopy in orthopaedic surgery

Objective. Surgical guidewires are commonly used in placing fixation implants to stabilize fractures. Accurate positioning of these instruments is challenged by difficulties in 3D reckoning from 2D fluoroscopy. This work aims to enhance the accuracy and reduce exposure times by providing 3D navigation for guidewire placement from as little as two fluoroscopic images.Approach. Our approach combines machine learning-based segmentation with the geometric model of the imager to determine the 3D poses of guidewires. Instrument tips are encoded as individual keypoints, and the segmentation masks are processed to estimate the trajectory. Correspondence between detections in multiple views is established using the pre-calibrated system geometry, and the corresponding features are backprojected to obtain the 3D pose. Guidewire 3D directions were computed using both an analytical and an optimization-based method. The complete approach was evaluated in cadaveric specimens with respect to potential confounding effects from the imaging geometry and radiographic scene clutter due to other instruments.Main results. The detection network identified the guidewire tips within 2.2 mm and guidewire directions within 1.1°, in 2D detector coordinates. Feature correspondence rejected false detections, particularly in images with other instruments, to achieve 83% precision and 90% recall. Estimating the 3D direction via numerical optimization showed added robustness to guidewires aligned with the gantry rotation plane. Guidewire tips and directions were localized in 3D world coordinates with a median accuracy of 1.8 mm and 2.7°, respectively.Significance. The paper reports a new method for automatic 2D detection and 3D localization of guidewires from pairs of fluoroscopic images. Localized guidewires can be virtually overlaid on the patient's pre-operative 3D scan during the intervention. Accurate pose determination for multiple guidewires from two images offers to reduce radiation dose by minimizing the need for repeated imaging and provides quantitative feedback prior to implant placement.

Highly Adhesive Antimicrobial Coatings for External Fixation Devices

Pin site infections arise from the use of percutaneous pinning techniques (as seen in skeletal traction, percutaneous fracture pinning, and external fixation for fracture stabilization or complex deformity reconstruction). These sites are niduses for infection because the skin barrier is disrupted, allowing for bacteria to enter a previously privileged area. After external fixation, the rate of pin site infections can reach up to 100%. Following pin site infection, the pin may loosen, causing increased pain (increasing narcotic usage) and decreasing the fixation of the fracture or deformity correction construct. More serious complications include osteomyelitis and deep tissue infections. Due to the morbidity and costs associated with its sequelae, strategies to reduce pin site infections are vital. Current strategies for preventing implant-associated infections include coatings with antibiotics, antimicrobial polymers and peptides, silver, and other antiseptics like chlorhexidine and silver-sulfadiazine. Problems facing the development of antimicrobial coatings on orthopedic implants and, specifically, on pins known as Kirschner wires (or K-wires) include poor adhesion of the drug-eluting layer, which is easily removed by shear forces during the implantation. Development of highly adhesive drug-eluting coatings could therefore lead to improved antimicrobial efficacy of these devices and ultimately reduce the burden of pin site infections. In response to this need, we developed two types of gel coatings: synthetic poly-glycidyl methacrylate-based and natural-chitosan-based. Upon drying, these gel coatings showed strong adhesion to pins and remained undamaged after the application of strong shear forces. We also demonstrated that antibiotics can be incorporated into these gels, and a K-wire with such a coating retained antimicrobial efficacy after drilling into and removal from a bone. Such a coating could be invaluable for K-wires and other orthopedic implants that experience strong shear forces during their implantation.

Peri-operative Antibiotic Prophylaxis in K-Wire Fixation: A Systematic Review and Meta-analysis

Introduction

There are currently no standardised guidelines on whether antibiotic prophylaxis is required for Kirschner wire (K-wire) fixation to minimise the risk of surgical site infection when used in patients undergoing clean orthopaedic surgery.

Purpose

To compare the outcomes of antibiotic prophylaxis versus no antibiotic in K-wire fixation when used in either in trauma or elective orthopaedics.

Methods

A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all randomised controlled trials (RCTs) and non-randomised studies comparing the outcomes of antibiotic prophylaxis group versus those without antibiotic in patients undergoing orthopaedic surgery in which K-wire fixation was used. Incidence of surgical site infection (SSI) was the primary outcome. Random effects modelling was used for the analysis.

Results

Four retrospective cohort studies and one RCT were identified with a total of 2316 patients. There was no significant difference between the prophylactic antibiotic and no antibiotic groups in terms of incidence of SSI (odds ratio [OR] = 0.72, P = 0.18).

Conclusions

There is no significant difference in administering peri-operative antibiotics for patients undergoing orthopaedic surgery using K-wire.

A Prospective Study Comparing the Infection Rate Between Buried vs Exposed Kirschner Wires in Hand and Wrist Fixations

INTRODUCTION

Kirschner wires (K-wires) are used in fracture fixations but are often associated with pin tract infections. This prospective study compared the infection rate between buried and exposed K-wires in closed injuries of the wrist and hands in individuals with no comorbidities.

METHODS

Fifteen patients were recruited with a total of 41 K-wires (21 buried K-wires; 20 exposed K-wires). Clinical and radiographic evidence of infection was assessed at three months based on the Modified Oppenheim classification.

RESULTS

Two out of 21 wires in the buried group developed grade 4 infection, while 20 wires in the exposed group did not have any significant infection. No significant difference in infection rate based on K-wire size or number in both groups.

CONCLUSION

There is no significant difference in infection rate between buried and exposed K-wires in healthy individuals with closed injuries of the wrist and hand.

Migrated K-wire in the urinary bladder not causing symptoms: A rare case report

INTRODUCTION AND IMPORTANCE

Kirschner wires (K-wires) are commonly used implants in the treatment of bony fracture. The migration of K-wire has been reported in the literature, but such migration into the urinary bladder is extremely rare.

PRESENTATION OF CASE

We report a case of an asymptomatic patient with a migrating K-wire in the urinary bladder, who came to our follow-up clinic after treatment of a hip fracture. The patient was absolutely fine but follow-up image showed K-wire in the urinary bladder. In view to prevent further migration and injuries, the laparotomy was planned and wire has been removed under the C-arm image guidance. Postoperative period was uneventful and patient was discharged.

CLINICAL DISCUSSION

The aim of reporting this case was to spread the awareness about mandatory follow-up after K-wire placement, its migration, and the recommendation to remove it at earliest. As per my best knowledge, this is the first and unique case of K-wire migration into the urinary bladder, detected on follow-up image without symptoms.

CONCLUSION

Bending the end of the K-wires after insertion, the restriction of joint movement, and removal of migrated K-wires at earliest are the key points in a patients with K-wire insertion. The mandatory follow-up in cases of K-wire placement for treatment of bone fracture, and early diagnosis prevent the potentially fatal complications.

The effect of grip location on Kirschner wire bend characteristics: An in vitro study

OBJECTIVE

To determine the effect of Kirschner wire (K-wire) grip location on bend angle, bend radius, and torque when performing a Z-bend technique.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Ten samples at each of five grip locations for each of three K-wire diameters.

METHODS

K-wires of three diameters (0.9, 1.1, 1.6 mm) were drilled into PVC pipe, and a Jacob's chuck was used to bend the wires at five periodic grip locations (distance from the bone model). Torque, bend angle, and bend radius were determined for each sample. Outcome variables were statistically analyzed by grip location to determine significant relationships.

RESULTS

A grip location of 2.0 cm in the 0.9 mm K-wire group minimized bend angle (mean ± SD: 75.92° ± 0.81) and bend radius (2.89 mm ± 0.08). A grip location of 3.0 cm in the 1.1 mm K-wire group minimized bend angle (72.88° ± 0.98) and bend radius (2.47 mm ± 0.20). A grip location of 3.0 cm minimized bend angle (74.38° ± 1.93) and bend radius (2.71 mm ± 0.27) in the 1.6 mm K-wire group. Torque at these grip locations for the 0.9, 1.1, and 1.6 mm K-wires was 6.50 N-m ± 0.0, 11.00 N-m ± 0.0, and 19.05 N-m ± 0.16, respectively.

CONCLUSION

Bend angle and bend radius can be minimized by bending K-wires at specific grip locations, though torque is not minimized at these locations. Clinical significance These findings provide an evidence-based recommendation of where surgeons should grip K-wires when bending them.

K-wire Fixation of Closed Hand Fractures Outside the Main Operating Room Does Not Increase Infections

Closed reduction and internal fixation (CRIF) of closed hand fractures in the main operating room (OR) is much more expensive than outside of the OR. However, there is a reluctance to fix fractures out of the OR due to the perceived increase in infections. Our goal was to prospectively analyze the infection rates of performing CRIF of closed metacarpal and phalangeal fractures in these two settings.

METHODS

A multicenter prospective analysis of patients undergoing CRIF of metacarpal or phalangeal fractures inside or outside the OR was performed. Demographic data, injury characteristics, surgery information and postoperative infectious complications were recorded, including cellulitis, frank pus, and osteomyelitis.

RESULTS

The study involved 1042 patients with a total of 2265 Kirschner-wires (K-wires). Infection rates were not statistically higher in the 719 patients who had CRIF outside of the OR (cellulitis 2.5%, frank pus 1.4%) compared with the 323 patients with CRIF in the OR group (cellulitis 3.4%, frank pus 2.5%). The OR group had a longer time to operation and a longer procedure time, but a shorter time with the K-wires in place.

CONCLUSION

K-wire fixation of closed hand fractures outside of the OR under field sterility is safe because it does not increase infectious complications compared to CRIF in the main OR under full sterility.

Bioresorbable implants vs. Kirschner-wires in the treatment of severely displaced distal paediatric radius and forearm fractures - a retrospective multicentre study

BACKGROUND

Distal 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 (AO 23r-M/3.1) and forearm (AO 23-M/3.1) fractures in children operated on with K-wires versus a novel technique with bioresorbable implants.

METHODS

We 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 24 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 and half year.

RESULTS

There 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.

CONCLUSIONS

Surgeries 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.

Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture

Metacarpal shaft fractures are common hand fractures. Although bone plates possess strong fixation ability, they have several limitations. The use of headless compression screws for fracture repair has been reported, but their fixation ability has not been understood clearly.This study aimed to compare the fixation ability of locked plate with that of headless compression screw for metacarpal fracture repair.A total of 14 artificial metacarpal bones (Sawbones, Vashon, WA, USA) were subjected to transverse metacarpal shaft fractures and divided into 2 groups. The first group of bones was fixed using locked plates (LP group), whereas the second group was fixed using headless compression screws (HC group). A material testing machine was used to perform cantilever bending tests, whereby maximum fracture force and stiffness were measured. The fixation methods were compared by conducting a Mann-Whitney U test.The maximum fracture force of the HC group (285.6 ± 57.3 N, median + interquartile range) was significantly higher than that of the LP group (227.8 ± 37.5 N; P < .05). The median of the HC group was 25.4% greater. However, no significant difference in stiffness (P > .05) was observed between the HC (65.2 ± 24.6 N/mm) and LP (61.7 ± 19.7 N/mm) groups.Headless compression screws exhibited greater fixability than did locked plates, particularly in its resistance to maximum fracture force.

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Background

Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side.

Objective

The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture.

Materials and methods

Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test.

Results

The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm).

Conclusion

According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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

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.

Intraoperative Kirschner Wire Breakage in a Pediatric Supracondylar Humerus Fracture

A displaced supracondylar humerus in a child is usually treated with closed reduction and percutaneous Kirschner (K)-wire fixation. The procedure is straightforward and usually yields excellent outcomes. In general, intraoperative complications are uncommon and intraoperative complications related to K-wires are exceedingly rare. We present the case of intraoperative K-wire breakage while performing closed reduction and K-wire fixation for a pediatric supracondylar humerus fracture. This unusual complication occurred while drilling through the medial cortex and the broken end of the K-wire disappeared under the skin in the cartilaginous distal humerus. The broken wire was removed by making an incision over the broken end. This report serves as a reminder to follow principles of drilling and avoid K-wire-related complications while performing percutaneous fixation of the pediatric supracondylar humerus fracture.

A Standardized Hand Fracture Fixation Training Framework using Novel 3D Printed Ex Vivo Hand Models: Our Experience as a Unit

Surgery for hand trauma accounts for a significant proportion of the plastic surgery training curriculum. The aim of this study was to create a standardized simulation training module for hand fracture fixation with Kirschner wire (K-wire) techniques for residents to create a standardized hand training framework that universally hones their skill and prepares them for their first encounter in a clinical setting.

Methods

A step-ladder approach training with 6 levels of difficulty on 3-dimensional (3D) printed ex vivo hand biomimetics was employed on a cohort of 20 plastic surgery residents (n = 20). Assessment of skills using a score system (global rating scale) was performed in the beginning and at the end of the module by hand experts of our unit.

Results

The overall average scores of the cohort before and after assessment were 23.75/40 (59.4%) and 34.7/40 (86.8%), respectively. Significant (P < 0.01) difference of improvement of skills was noted on all trainees. All trainees confirmed that the simulated models provided in this module were akin to the patient scenario and noted that it helped them improve their skills with regard to K-wire fixation techniques, including improvement of their understanding of the 3D bone topography.

Conclusions

We demonstrate a standardized simulation training framework that employs 3D printed ex vivo hand biomimetics proved to improve the skills of residents and that paves the way to more universal, standardized and validated training across hand surgery. This is, to our knowledge, the first standardized method of simulated training on such hand surgical cases.

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Background

Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.

Objective

We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.

Materials and methods

We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.

Results

The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.

Conclusion

Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Broken Kirschner Wires Can Migrate: A Case Report and Review of Literature

Introduction

Kirschner wires are in use in orthopedic and trauma surgery since the past 80 years. These wires can break due to metal fatigue and migrate which can cause lethal complications.

Case Report

A 27-year-old female sickle cell patient with avascular necrosis of the head of femur, drilling, and injection of the osteoblasts in the head of femur was being performed. A 2 cm of 2.0 mm proximal tip of the guide wire broke. Discussion started whether to leave the wire and the young decided to leave the broken wire, but the wisdom directed us to remove it.

Conclusion

Migration of wires does occur, we believe not only broken wires should be removed but also even the unbroken wire to be removed once the purpose of use is achieved.

Tibial Apophyseal Percutaneous Pinning in Skeletally Immature Dogs: 25 Cases (2016-2019)

OBJECTIVE

 The aim of this study was to report the clinical experience with fluoroscopically guided tibial apophyseal percutaneous pinning (TAPP) for tibial tuberosity avulsion fractures (TTAF).

STUDY DESIGN

 This is a retrospective case series.

MATERIALS AND METHODS

 Medical records of skeletally immature dogs (n = 25) were reviewed. The association of pin design [smooth (SP); negatively threaded (NTP)], pin insertion angles, TTAF-type, age and breed with various outcome variables was statistically evaluated. Long-term follow-up was assessed via direct examination, radiographs, questionnaires and videos.

RESULTS

 Mean age, weight and surgery times were 6.2 months, 9.6 kg and 21 minutes respectively. No major complications occurred among the 19 SP and 6 NTP; no pin broke. Seromas and patellar desmitis rates were higher with SP (11/19; 16/19) versus NTP (0/6; 2/6) (p = 0.02; 0.03). The median horizontal pin cross angles for cases without and with desmitis were 40 and 26 degrees respectively (p = 0.047). Explantation was needed in 5/19 SP and 0/6 NTP cases. The mean tibial plateau angle (TPA) changed significantly between initial (25.6 degrees) and follow-up (18.8 degrees) radiographs (p = 0.0002). Long-term outcome, obtained at a mean of 19.9 months, was excellent in all cases.

CONCLUSION

 Tibial apophyseal percutaneous pinning can be considered to treat TTAF. Divergent pin placement and using NTP might reduce complications. Tibial plateau angle should be monitored until skeletal maturity has been reached. Long-term outcome post TAPP can be expected to be excellent.

Retroperitoneal Kirschner wire migration after surgical treatment in a patient with cerebral palsy

Although Kirschner (K)-wire is among the most commonly used implants in orthopedic surgeries, the migration of this material is a very rare complication. In this article, we present the case of a K-wire migration four years after the surgery detected during the routine control of a 10-year-old male patient who underwent surgical treatment due to the diagnosis of developmental hip dys- plasia on the cerebral palsy. The aim of this study was to raise the awareness regarding this complication particularly for the pediatric orthopedic surgeons, and to recommend the removal of the K-wire as soon as bone union occurs.

Iatrogenic metacarpal fracture after K-wire fixation: A case report and prevention

•

There are possibility of iatragenic fracture anywhere K-wire have passed and failed.

•

Surgeons should be aware of the potential damage to bone during K-wire fixation.

•

Preoperative planning, continuous C-arm scanning and appropriate K-wire thickness can minimize complications.

•

Patients should be told that following K-wire removal, the residual holes could subject to stress risers.

Introduction

Iatrogenic fractures after failed K-wire fixation in the management of a carpometacarpal (CMC) joint fracture-dislocation have not yet been reported (Hsu et al., 2011). We present a case of K-wire-related complication in the management of a CMC joint fracture-dislocation and highlight the importance of planning K-wire placement and minimizing the number of K-wire passes.

Presentation of case

After beating his hand against a wall, a 22-year-old patient visited our clinic complaining of a swollen and painful wrist. Following our protocol, reduction and K-wire fixation was planned. During these procedures, the resident of our team made several attempts to insert transfixation pins and radiologic finding demonstrated incorrect placement of the K-wire track. The patient visited the outpatient clinic at 5 weeks postoperatively then we removed the K-wires and began mobilization. Two weeks later, the patient came back with acute onset of pain and swelling at the 5th metacarpal area.

Discussion

Stahl and Schwartz reported that 27.8 % of complications related K-wire were due to technical failure and 90 % of technical failure were caused by hospital residents. Well-established guidelines and supervision by a highly experienced surgeon is likely to reduce the rate of technical failure. Multiple passes of the K-wire have resulted in blunting of the K-wire and subsequent heat generation then lead to subsequent loosening and loss of fixation.

Conclusion

Preoperative planning, marking the K-wire route, and appropriate K-wire thickness minimize such complications. Patients should be informed that following K-wire removal, the residual holes could be subject to stress risers.

Olecranon Fractures in Pediatric Patients With Osteogenesis Imperfecta

BACKGROUND

Osteogenesis imperfecta (OI) is a hereditary disorder characterized by an abnormality of the quality or quantity of type I collagen, leading to bone fragility. Fractures in children with OI may result from minor trauma and have atypical patterns. Previous studies have found a strong relationship between olecranon fractures and OI in pediatric populations, but the characteristics of olecranon fractures within the OI patient population have not been fully described.

METHODS

We reviewed the records of 358 children with a diagnosis of OI. Of those, 29 had at least 1 olecranon fracture. We collected general information relating to the patient's diagnosis of OI including OI type, fracture history, mobility, and bisphosphonate treatment. Information regarding the fracture, treatment, and the occurrence of bilateral fractures were recorded, as well as weight, height, and axial bone mineral density z-score from the time of the fracture.

RESULTS

Within our OI population of 358 patients, we found an incidence of olecranon fracture of 8.1% (29 patients). The olecranon fractures occurred predominantly in the type I population (27 of 29). Within the population of patients specifically with OI type I (200 patients) the incidence is 13.5%, with 6% of OI type I patients sustaining bilateral olecranon fractures. The percentage of children with one olecranon fracture subsequently sustaining another on the contralateral side was 41.4%. The mean time to the second fracture was 5 months. The mean age at the time of the first olecranon fracture was 11.9 years old. The average axial bone mineral density z-score was -2.5 for primary fractures. All 12 patients who suffered a contralateral olecranon fracture had OI type I.

CONCLUSIONS

Olecranon fractures in the OI population occur most commonly in patients with type I OI and during early adolescence, a period of rapid growth. There is a high rate of bilateral olecranon fractures, with the contralateral fracture occurring quickly after the primary fracture. Further studies may elucidate risk factors to determine which patients are most likely to fracture the contralateral side and therefore drive treatment and potentially prevention.

LEVEL OF EVIDENCE

Level IV-retrospective cohort study.

Corrosion and bone healing of Mg-Y-Zn-Zr-Ca alloy implants: Comparative in vivo study in a non-immobilized rat femoral fracture model

Biodegradable magnesium (Mg) alloys exhibit improved mechanical properties compared to degradable polymers while degrading in vivo circumventing the complications of permanent metals, obviating the need for surgical removal. This study investigated the safety and efficacy of Mg-Y-Zn-Zr-Ca (WZ42) alloy compared to non-degradable Ti6Al4V over a 14-week follow-up implanted as pins to fix a full osteotomy in rat femurs and as wires wrapped around the outside of the femurs as a cerclage. We used a fully load bearing model allowing implants to intentionally experience realistic loads without immobilization. To assess systemic toxicity, blood cell count and serum biochemical tests were performed. Livers and kidneys were harvested to observe any accumulation of alloying elements. Hard and soft tissues adjacent to the fracture site were also histologically examined. Degradation behavior and bone morphology were determined using micro-computed tomography scans. Corrosion occurred gradually, with degradation seen after two weeks of implantation with points of high stress observed near the fracture site ultimately resulting in WZ42 alloy pin fracture. At 14 weeks however, normal bone healing was observed in femurs fixed with the WZ42 alloy confirmed by the presence of osteoid, osteoblast activity, and new bone formation. Blood testing exhibited no significant changes arising from the WZ42 alloy compared to the two control groups. No recognizable differences in the morphology and more importantly, no accumulation of Mg, Zn, and Ca in the kidney and liver of rats were observed. These load bearing model results collectively taken, thus demonstrate the feasibility for use of the Mg-Y-Zn-Zr-Ca alloy for long bone fracture fixation applications.

Unusual migration of a Kirschner wire in a patient with Osteogenesis Imperfecta: A case report

RATIONALE

Kirschner wires (K-wires) are the most commonly used implants in orthopedic surgery. Although complications are not uncommon, they are mostly benign in nature and easily managed. While migration of K-wires is a rare complication, fatal outcomes have been reported. A review of the literature showed that only 7 cases of wire migration in the hip and pelvic region have been reported. Only 2 occurred in the pediatric population. Although K-wires are routinely used in osteogenesis imperfecta (OI) patients, there has been no report of complications in this vulnerable patient population.

PATIENT CONCERNS

A 10-year-old girl with OI, presenting with gastrointestinal symptoms 1 year after operative fixation of a subtrochanteric femoral fracture. Pelvic x-ray showed a missing K-wire.

DIAGNOSIS

The patient was diagnosed with migration of a K-wire from the left femoral neck to the right retroperitoneal space.

INTERVENTIONS

The patient underwent surgery. During the operation, the migrated K-wire was extracted from just below the 12th rib on the right side.

OUTCOMES

The patient had an uneventful rehabilitation, recovered completely, and was asymptomatic at 2-year follow-up.

LESSONS

There has been no prior report of migrated K-wires in the OI population. This is also the first report of a K-wire migrating from the femoral neck to the contralateral retroperitoneal region. Proper intraoperative bending of K-wires, timely removal of temporary K-wires, and considering K-wire migration in patients with retained hardware complaining of respiratory or gastrointestinal symptoms will prevent potentially life-threatening complications.

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

Background

Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates.

Methods

We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types.

Results

The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm).

Conclusion

The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.

Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room

BACKGROUND

The purpose of this study was to compare closed reduction and percutaneous pinning of metacarpal and phalanx fractures performed in the operating room (OR) versus the procedure room of the emergency department with primary outcomes being infection rate, radiographic union, and monetary cost.

METHODS

From January 2006 to December 2010, all closed reduction and percutaneous pinnings of metacarpal and phalanx fractures (CPT codes: 26608; 26727) by a single board-certified hand surgeon (A.M.H.) were retrospectively reviewed. Patients were placed into 2 groups: Group 1 was patients treated in the OR, and group 2 was patients in an emergency department procedure room. Infection, malunion, and nonunion rates were compared using a chi-square test. Charges were compared using a t-test, and cost of supplies and labor was evaluated.

RESULTS

A total of 189 patients met final inclusion criteria for this study: 130 in group 1 and 59 in group 2. There was no statistically significant difference in infection rates ( P = .13), nonunion ( P = .40), malunion rates ( P = .89), and hardware failure with revision ( P = .94) between the 2 groups. The procedure room patients had an average hospital charge of $1358.55 compared with $3691.85 for OR-treated patients (P = .001). The total cost of supplies and nonphysician labor was $432.31 per OR case and $179.59 per procedure room case.

CONCLUSIONS

Metacarpal and phalanx fractures of the hand amendable to closed reduction and percutaneous pinning can be treated in the procedure room with no increase in risk of infection, malunion, or nonunion rates. In addition, these surgeries can be performed in a procedure room with lower cost and less charges to patients than in the operating room.

Should we bury K-wires after metacarpal and phalangeal fracture osteosynthesis?

BACKGROUND

Burying Kirschner wires (K-wires) under the skin after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal.

PURPOSE/AIM OF STUDY

To examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires.

MATERIALS AND METHODS

Metacarpal and phalangeal fractures treated with K-wire osteosynthesis at our institution from 1st of January, 2009 to 1st of February, 2015 were identified retrospectively. The final study population included 444 patients, 331 with metacarpal, 109 phalangeal and 4 with mixed fractures. Surgical and patient records were examined 90 days postoperatively.

FINDINGS/RESULTS

337 patients (75.9%) were treated with buried K-wires and 107 patients (24.1%) with exposed (non-buried) K-wires. 14 patients (4.1%) treated with buried K-wires presented with postoperative infection, opposed to 7 patients (6,5%) treated with non-buried K-wires (p = 0.311). None of the postoperative infections caused re-operation. Only one case of deep/severe infection was recorded in a patient treated with buried K-wires requiring intravenous antibiotic treatment. In 58 of 337 patients (17.2%) treated with buried K-wires, removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed in the out-patient clinic without re-operation.

CONCLUSIONS

We found no difference in postoperative infection rate between metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. However, the high readmission and reoperation rate (17.2%) after burying K-wires should call for reconsideration of surgical strategies.

[Kirschner wire osteosynthesis for fractures in childhood: bury wires or not? : Results of a survey on care reality in Germany]

INTRODUCTION

Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires.

METHODS

A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed.

RESULTS

A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique.

CONCLUSION

In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.

Surgical Repositioning of the Premaxilla Using a Minimally Invasive Endonasal Approach

Objective:

The aim of this study was to evaluate a technique for the surgical repositioning of the premaxilla using a minimally invasive endonasal approach.

Design:

Retrospective review of clinical records.

Setting:

Tertiary care, University Hospital, pediatric maxillofacial surgery unit.

Patients:

Twenty-one patients (12 boys and 9 girls), ages ranging from 6 to 21 years, with BCLP+A and premaxillary malposition (PM).

Interventions:

Surgical repositioning of the premaxilla (SRP) using a minimally invasive endonasal approach, from November 2007 to November 2015.

Main outcome measures:

Achieving maxillary arch alignment and premaxillary stability was defined as treatment success. Intraoperative and postoperative complications were also recorded.

Results:

In all cases (100%), the treatment was successful either at first surgery or after reoperation. Two patients (9.5%) were reoperated-one due to premaxillary instability and one due to PM relapse. There were no perioperative complications.

Conclusions:

SRP using a minimally invasive endonasal approach is a safe and effective technique that levels and aligns the maxillary arch in preparation for SABG, which minimizes the risk of wound infection and premaxillary vascular compromise. The endonasal approach improves tissue quality of the mucoperiosteal flaps when performing the SABG procedure. Further prospective studies are needed to elucidate the best protocols and techniques for the management of PM in patients with BCLP+ A.

Novel Antibacterial Coating on Orthopedic Wires To Eliminate Pin Tract Infections

Novel approaches to the prevention of microbial infections after the insertion of orthopedic external fixators are in great demand because of the extremely high incidence rates of such infections, which can reach up to 100% with longer implant residence times. Monolaurin is an antimicrobial agent with a known safety record that is broadly used in the food and cosmetic industries; however, its use in antimicrobial coatings of medical devices has not been studied in much detail. Here, we report the use of monolaurin as an antibacterial coating on external fixators for the first time. Monolaurin-coated Kirschner wires (K-wires) showed excellent antibacterial properties against three different bacterial strains, i.e., methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), and Staphylococcus epidermidis Approximately 6.0-log reductions of both planktonic and adherent bacteria were achieved using monolaurin-coated K-wires, but monolaurin-coated K-wires did not show any observable cytotoxicity with mouse osteoblast cell cultures. Overall, monolaurin-coated K-wires could be promising as potent antimicrobial materials for orthopedic surgery.

Migration of a Kirschner wire to the dorsolateral side of the foot following osteosynthesis of a patella fracture with tension band wiring: a case report

Background

Patella fractures represent 1 % of all musculoskeletal system fractures. Fixation of patellar fractures using open reduction and tension band wiring is a commonly used and successful surgical fixation method.

Case presentation

A 28-year-old male patient from Turkey presented to our clinic with complaints of palpable foreign bodies under the skin on the dorsolateral side of his right foot. Except for the palpable and moving body of about 6 cm length under the skin in his foot, he had no functional complaints. On X-ray, a Kirschner wire was visible in front of the lateral malleolus on the dorsolateral side of his right foot. In addition, there was a cerclage wire from the tension band fixation of his patella in the ipsilateral knee. The Kirschner wire was removed surgically.

Conclusion

Despite the use of different fixation materials for the surgical treatment of patellar fractures, tension band wiring is still a commonly used technique. We recommend that after fixation of a patellar fracture using the tension band wiring technique, the ends of the Kirschner wires be bent and the wires then removed in the early phase after patellar union to prevent Kirschner wire migration.

Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study

PURPOSE

The purpose of our study was to determine the long-term functional outcomes of pin tract infection after percutaneous pinning of displaced supracondylar humeral fractures in children, and to evaluate the potential for intracapsular pin placement based on pin configuration in cadaveric elbows.

METHODS

We conducted a retrospective review of all patients requiring percutaneous pinning in a single institution over a 19-year period. The functional outcome assessment consisted of a telephone interview using the Disabilities of the Arm, Shoulder and Hand (DASH)] Outcome Measure and the Patient-Rated Elbow Evaluation (PREE) questionnaires. The risk of intracapsular pin placement was studied in cadaveric elbows for the three most common pin configurations: divergent lateral, parallel lateral, and medial and lateral crossed pins.

RESULTS

Of 490 children, 21 (4.3 %) developed pin tract infection. There were 15 (3.1 %) superficial and six (1.2 %) deep infections (osteomyelitis and septic arthritis). Both DASH and PREE scores were excellent at a mean of 18 years post-surgery. The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations.

CONCLUSIONS

Most infections after pinning of supracondylar humerus fractures are superficial and can be managed with pin removal, oral antibiotics, and local wound care. Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study. Satisfactory long-term outcomes of these deep infections can be expected when treated aggressively with surgical debridement and intravenous antibiotics.

Kirschner wire migration into intramedullary canal of ulna during open reduction and internal fixation

At Bunbury Regional Hospital, we recently saw a case where Kirschner wires (K-wires), used during open reduction and internal fixation of olecranon, were propelled down the intramedullary canal intraoperatively. The K-wire was only secured unicortically. From our experience, we have developed steps to prevent this complication. First, where the wires are being used as part of a tension band wire construct, we suggest drilling the distal hole prior to the placement of the K-wires and, secondly, where K-wires are being used to secure the fracture fragment, the K-wires can be secured with artery clips to ensure that the wires remain in position.

Complications of Kirschner-wire fixation in distal radius fractures

Distal radius and ulna fractures are the most common fractures seen in England, occurring at a rate of 22/10,000 person years. Kirschner (K)-wire fixation is a well-accepted method of treating these fractures. There is a surprising paucity of evidence on the subject of prophylactic antibiotics and the duration of K wires can be left in, as these relate to infection rates. We therefore present the results of our protocol for distal radius K-wire fixation for which: no antibiotic prophylaxis was given; we used a percutaneous (not buried) technique, where the K wires were removed after 4 weeks, and the patient has a total of 6 weeks in cast (last 2 wk without wires). The results of the last 100 consecutive patients who were treated with manipulation and K wiring of dorsally displaced distal radial fractures in a standard district general hospital over a 2-year period were analyzed retrospectively. A total of 100 patients had 176 K wires inserted. The mean age was 32.5 years. The mean time to pin removal was 29.4 days. The infection rate was 2%. These results illustrate a safe and clinically effective protocol for K-wire fixation in treating distal radius fractures. On the basis of this study, we do not advocate the use of prophylactic antibiotics, postulating that they do not affect infection rate and thereby eliminating potential antibiotic adverse effects. Furthermore, we do not bury the K wires, which allows for their removal in clinic, thus preventing risks of further operative procedures.

Complications of transcutaneous metal devices

A high incidence of associated infection with the use of transcutaneous metal devices has been widely reported. The aims of this study were: (1) to record the incidence of pin site infection in a Plastic Surgery department, (2) to compare the infection rate in our department with published literature and (3) to identify factors that contribute to infection. A prospective cohort study was performed including all patients presenting to the plastic surgery unit with any type of transcutaneous metal in situ over a 3-month period. Patients and staff were questioned on wound hygiene and whether they had been provided with specific protocols. Our study revealed an infection rate of 24%. Patients and staff were not aware of preventive protocols. From this study, the following conclusions are made: (1) pin site infection is a major problem, and no consensus has been reached on the best way to manage pin sites, (2) there is variable knowledge of pin-site care, (3) there is a need for a clearer definition of pin-site infection and a standardised system of assessment, classification and treatment and (4) there is a need for more innovative technology in pin-site manufacture as studies reveal that the type of material used in the pins does affect infection rates.

Complications of K-wire fixation in procedures involving the hand and wrist

PURPOSE

Surgeons often use smooth K-wires for bone stabilization in the hand and wrist. The purposes of this study were to observe the incidence of postoperative complications of K-wire fixation in the hand and wrist and to identify associated risk factors.

METHODS

A total of 189 patients underwent bone and soft tissue procedures in the hand and wrist with insertion of 408 smooth K-wires. All patients were instructed to comply with a uniform pin care protocol and were observed for a minimum of 1 examination after pin removal. Complications were categorized as minor or major, with 3 subcategories for infectious complications. We compared total complications and infectious complications with patient age, comorbidities, soft tissue integrity, pin exposure (external or buried), number of pins inserted, pin location, compliance with pin site care, and empiric antibiotic treatment.

RESULTS

We found that 39 patients experienced postoperative complications involving 58 K-wires (14% of all pins). Most complications were minor, commonly superficial pin track infection (24 pins, 6% of all pins). Major complications occurred less frequently (11 pins, 3% of all pins) and included complications that led to additional surgery (deep infection, malunion, or nonunion) and fractures through the pin track. The development of an infectious complication was associated with 2 factors: pin location in the hand versus the wrist and poor compliance with pin site care. Patient age, medical comorbidities, soft tissue integrity, pin exposure, number of pins inserted, and empiric antibiotic treatment had no statistically significant relationships to the occurrence of complications.

CONCLUSIONS

Complications with smooth K-wire fixation in the hand and wrist are relatively uncommon. Most complications involve minor, superficial pin track infections. Location of pins in the hand as compared with the wrist and poor patient compliance with pin site care may increase the risk of infection.

Acutely calcified hematoma mimicking a displaced medial epicondyle fracture

We present an interesting and unusual case of an acutely calcified pin-site infection hematoma mimicking a displaced cartilaginous medial epicondyle, in a child with a Gartland type III fracture. The treatment of such pathology could be confusing and may interfere with the correct clinical decision-making process. To our knowledge, this is the first presentation of such a case.