Efficacy of allogeneic tendon material coracoclavicular ligament reconstruction combined with Kirschner wire and titanium alloy hook plate material fixation in the treatment of acromioclavicular joint dislocation

Objective

To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation.

Methods

From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6 months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups.

Results

All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3 days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group.

Conclusion

The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Patellar Avulsion Fracture

We report on the case of a 52-year-old male who sustained a transverse patellar fracture after tripping on uneven pavement. These fractures can be easy to miss on anteroposterior views, highlighting the importance of multiple radiographic views of the knee. Examination of the knee is also important, as initial clinical appearance can be benign. These fractures are most often seen in adolescents, which makes the current case somewhat unusual.

The long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint

Purpose

To evaluate the long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint.

Methods

From July 2016 to September 2021, 21 patients with fracture-dislocation of the fifth carpometacarpal joint were treated with trans-articular plate combined with Kirschner wires internal fixation. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, the time between injury and surgery, the range of motion of the bilateral wrist in flexion, extension, radial deviation and ulnar deviation, grip strength of each side, the time of return to work, and follow-up time were recorded. The QDASH score and Cooney wrist function score were used to evaluate the postoperative function. The VAS system was used to evaluate postoperative pain.

Results

The follow-up time was 37.0 ± 19.0 months and the time between injury and surgery was 1.3 ± 0.5 days. In the injured side and the contralateral side, the range of motion of the wrist flexion were 58.3 ± 4.0° and 60.5 ± 3.1°, the range of motion of the wrist radial deviation were 25.7 ± 3.3° and 26.9 ± 2.9°, the range of motion of the wrist ulnar deviation were 28.1 ± 3.7° and 29.5 ± 3.1° respectively with no significant difference. The range of motion of the wrist extension (54.0 ± 3.4°) in the injured side was smaller than that in the contralateral side (56.7 ± 3.7°) with significant difference. The grip strength of the injured side and the contralateral side were 96.1 ± 9.5 LB and 100.7 ± 9.7LB respectively with no significant difference. The QDASH score was 3.8 ± 1.8, Cooney wrist function score was 94.5 ± 4.2, VAS score was 1.0 ± 0.8 and the time of return to work was 5.1 ± 0.9 weeks. In the 21 cases, no postoperative complications such as incision infection, failure of internal fixation, fracture nonunion or fracture malunion occurred.

Conclusion

The method of trans-articular plate combined with Kirschner wires is one of the alternative treatments for the fracture-dislocation of the fifth carpometacarpal joint. The long-term follow-up results were satisfactory.

Clinical outcomes of closed, displaced phalangeal neck fractures in children with different types of kirschner wire fixation: A retrospective observational study

Objectives

Inappropriate treatment of Closed displaced phalangeal neck fractures (CDPNF) in children usually leads to poor outcomes.This study was to evaluate the clinical outcomes of closed/open reduction, age, and different types of fracture and Kirschner wire (K-wire) fixation in the treatment of CDPNF.

Materials and methods

Participants: Sixty patients (male, 46 and female,14; right-handed, 35 and left-handed, 25; mean age, 7.9-years-old [range, 1.0-14.5 years]) who had CDPNF were included. Preoperative x-rays showed that the fractures were displaced and exhibited obvious deformities. Interventions: First, reduction (four cases of open reduction and 56 cases of closed reduction) was performed followed by percutaneous K-wire fixation (cross fixation, 24 cases; longitudinal and slanting fixation, 17 cases; homolateral fixation, four cases; and single longitudinal fixation, 15 cases,) and immobilized by cast. x-ray examination following removal of the K-wires showed that the fractures were healed; the criteria for fracture healing were callus formation and the absence of fracture lines. Clinical outcome and radiographs between groups were compared.

Results

According to the visual analogue scale, the pain scores were excellent. According to the Al-Qattan Grade system(AGS),all the patients presented with closed, type II phalangeal neck fractures,the results were excellent in 36 cases (36/60, 60%), good in 15 cases (15/60, 25%), fair in 5 cases (5/60, 8.3%) and poor in 4 cases (4/60, 6.7%). There were significant differences in different fracture type groups (P  = 0.013*), operation age groups (P  = 0.025*) and open/closed reduction groups (P  = 0.042*). There was no significant difference in K-wire fixation type groups (P  > 0.05).

Conclusions

Patients with open reduction, the more serious fracture type, the older at the operation, were more likely to have poor AGS result. Different K-wire fixation types for CDPNF in children had the same satisfactory results.

Evolution of a traditional technique: Comparison of a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner technique with anti-gliding miniplate fixation for the treatment of medial malleolar fractures

BACKGROUND

In this study, we aimed to compare a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner wire (K-wire) technique with additional miniplate fixation for the treatment of medial malleolar fractures.

METHODS

A total of 23 patients who were diagnosed with isolated fractures of the medial malleolus and operated in our center were retrospectively analyzed. The patients were divided into two groups: Group A, medial malleolar fracture fixed with a 4-mm cannulated screw and a K-wire (n=11) and Group B, a 4-mm cannulated screw and K-wire used for fixation with miniplate fixation for extra stability (n=12). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 2, 6, 12, and 24 months postoperatively. At 12-24 months, the presence of pain and tenderness in the medial malleolus with palpation was evaluated using the visual analog scale (VAS) pain scores.

RESULTS

The mean time to union was 2.23±0.56 (range, 1.8-2.9) months in Group A and 2.46±0.45 (range, 1.9-3.1) months in Group B, indicating no statistically significant difference between the two groups (p>0.05). The mean AOFAS score at 2 months postoperatively was 60.40±7.78 (range, 46-79) in Group A and 73.60±10.80 (range, 53-87) in Group B, indicating a statistically significant difference between the groups (p<0.01). However, there was no statistically significant difference in the mean AOFAS scores at 6 and 12 months between the groups (p>0.05). The mean VAS pain scores at 12-24 months postoperatively did not significantly differ between the groups (p>0.05).

CONCLUSION

Our study results suggest that the treatment of medial malleolar fractures with a cannulated screw and K-wire with additional stabilization using a miniplate ensures favorable early outcomes with early return to daily living activities. However, both techniques have similar outcomes in the mid-term.

Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures: A retrospective study

The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures.We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups.The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable (P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ± 7.23 vs 25.64 ± 6.29; 7.13 ± 2.38 vs 5.26 ± 1.71; 67.43 ± 22.01 vs 52.57 ± 17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score (P < .05).Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.

Comparison of single and double dorsal wires in the extension block technique for mallet fractures: Retrospective observational study

Mallet fractures are avulsion fractures of the extensor tendon from the distal phalanx base and often occur due to sudden flexion or axial loading. In this study, we aimed to compare the clinical and radiological results of patients treated with single and double dorsal wires from the dorsal in the extension block method.Patients to whom a single wire from dorsal was applied were assigned to Group 1 (n: 22), and those to whom double wires were applied were assigned to Group 2 (n: 23). Surgical treatment was decided for patients with more than 1/3 of the fracture fragment containing the joint surface and volar subluxation. The range of motion of the distal interphalangeal (DIP) joint was measured with a goniometer. The displacement of the fragment was measured before and after surgery on lateral radiographs. The presence of bridging callus formation on anterior-posterior and lateral radiographs was evaluated for a union.There were 30 male (66.7%) and 15 (33.3%) female patients. The mean age of the patients was 32 years. Radiographic union was obtained in all patients. Pseudoarthrosis was not observed in any patient. The Crawford score was excellent in 13 (28.9%) cases, the score was good in 18 (40%) cases, the scores were moderate in 13 (28.9%) cases, and the score was poor in 1 case (2.2%). There were no complications in 35 (77.8%) cases, dorsal bump complications occurred in 9 cases (20%), and osteoarthritis and dorsal bump complications occurred in 1 (2.2%) case. We did not observe nail deformity, skin necrosis, infection, or fingertip sensitivity. We found similar functional and clinical results between the groups.We recommend using single dorsal wire, as using double dorsal wires requires extra operation time, effort, and fluoroscopy.

Is biodegradable pin a good choice for lateral condylar fracture of humerus in children: A comparative study of biodegradable pin and Kirschner wire

INTRODUCTION

Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW.

MATERIAL AND METHODS

Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group.

RESULTS

In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group (P < .001).

CONCLUSIONS

Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.

Closed reduction with crossed Kirschner wire fixation for displaced supracondylar femoral fractures in young children

Supracondylar femoral fractures are uncommon in children, but may result in various deformities. Though many approaches have been used to manage them, there is no literally approved standard yet.From 2015 to 2017, 12 young children at the average age of 2.5 years old (range 3.6-1.6) with displaced supracondylar fractures were admitted to our department and received closed reduction with crossed Kirschner wire (K-wire) fixation as treatment. After the surgeries, we performed follow-up to every patient at the average length of 26 months (range 24-30) and used the Knee Society Score scale to evaluate the outcome.Fracture healing was observed within 10 weeks for all patients and walking was resumed between 10 to 13 weeks. No patient reported a valgus deformity more than 10°, neurovascular injury or knee infection. The average limb length discrepancy was 0.4 cm at the end of our follow-up. Every patient had perfect score on the Knee Society Score scale.Our study suggests that closed reduction with percutaneous crossed Kirschner wire is a favorable method for displaced supracondylar femoral fractures in young children.

Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures

This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.

Auxiliary Kirschner wire technique in the closed reduction of children with Gartland Type III Supracondylar humerus fractures

This study aimed to investigate the effect of auxiliary Kirschner wire (K-wire) technique in the closed reduction of children with Gartland type III supracondylar humerus fractures by comparing with manual reduction alone.Retrospective analysis was performed on the clinical data of 68 cases of supracondylar humerus fractures. Thirty-six patients received closed reduction and percutaneous fixation with auxiliary K-wire technique (group A). Thirty-two patients received conventional manual reduction and percutaneous pin fixation (Group B).In group A, the average operation time was 20.5 ± 8.5 minutes, the average frequency of intraoperative radiographic observations was 4.3 ± 1.1, the average fracture healing time was 6.2 ± 1.8 weeks, and the complication rate was 3/36, 8.3%. The mean operation time was 36.1 ± 10.2 minutes, the average frequency of intraoperative radiography was 8.9 + 1.7 times, the average fracture healing time was (6.1 ± 1.6) weeks, and the complication rate was 2/32, 6.3%. The operation time in group A was significantly shorter than that in group B. The difference between the 2 groups was statistically significant (P = .012). The frequency of radiography in group A was significantly less than that in group B (P = .001).Compared with manual reduction, auxiliary K-wire technology can significantly shorten the operation time, reduce the radiant quantity of the surgeon, improve the efficiency of closed reduction of children with Gartland type III supracondylar humerus fractures, and reduce the risk of developing postoperative complications. And meanwhile, there is no significant effect on the imaging and functional outcomes of affected extremities, which is worthy of respect.

First-stage scapholunate fusion for the treatment of a chronic lunate dislocation: A case report

RATIONALE

Lunate dislocation is a rare injury to the wrist caused by high-energy trauma, and poor prognosis is often associated with missed initial diagnosis. To date, there is no consensus regarding an effective treatment plan for such cases.

PATIENT CONCERNS

Here, we describe the case of a 36-year-old man who presented with lunate dislocation following a delay in diagnosis of over 7 weeks, and further illuminate its diagnosis and treatment.

DIAGNOSIS

The diagnosis of chronic lunate dislocation was rendered.

INTERVENTIONS

The patient was treated using reduction via the dorsal approach brachial plexus anesthesia. After the reduction, a headless compression screw fixation was performed for first-stage scapholunate fusion, and Kirschner wire fixation of the lunate-triquetrum-hamate was used to stabilize the distal and proximal carpal rows.

OUTCOMES

The patient was followed up for 1 year and showed wrist function recovered well; radiographic examination showed no lunate dislocation and successful scapholunate bony fusion. A satisfactory outcome was achieved.

LESSONS

The case study presented here provide evidence that performing an effective first-stage scapholunate fusion is recommended to achieve better therapeutic outcomes for a chronic lunate dislocation. Furthermore, this approach led to a good long-term clinical outcome in our case.

A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip

We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip.From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well.All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage.Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.

Results of arthroscopic fixation of Mason type II radial head fractures using Kirschner wires

The goals of this study are to report an arthroscopic technique for the treatment of Mason type II radial head fractures using Kirschner wires (K-wires), and investigate the feasibility and evaluate the results.We retrospectively review 18 cases of closed Mason type II radial head fractures treated in our institution from August 2010 to May 2015. There were 13 males and 5 females with an average age of 30.6 (17-45 years) years. Injuries were caused by falling in 8 cases, by traffic accidents in 5 cases, and by sports in 5 cases. The average time from injury to admission was 3.9 days (1-11 days). All radial head fractures were confirmed on x-ray and computed tomography. The fracture fragments were fixed with percutaneous K-wires under arthroscopy.All surgical wounds healed with primary closure, and no complication occurred, such as neurovascular injury, infection, or hardware failure. All patients were followed up for a mean period of 19 months (range: 14-29 months). Bone union was achieved for all patients with a mean time of 11 weeks. At final follow-up, range of motion of the elbow has no significant difference in comparison to the uninjured side. The mean Visual Analog Scale for these patients was 1.7 (range 0-3). According to the Broberg-Morrey score, there were 7 excellent, 9 good, 2 fair, and 0 poor results (with good or excellent results in 89%). Mayo elbow performance score and the disabilities of the arm, shoulder, and hand score were significantly improved postoperatively.The present study demonstrates that arthroscopic fixation of Mason type II radial head fractures using K-wires provided a stable fixation with good clinical outcomes and patient satisfaction.

Volar locking plates versus K-wire/pin fixation for the treatment of distal radial fractures: a systematic review and quantitative synthesis

INTRODUCTION

Volar locking plate and Kirschner wire/pin fixations are the most commonly used methods for surgical fixation of distal radius fractures.

SOURCES OF DATA

A literature search was performed using PubMed, CINAHL, Cochrane Central and Embase Biomedical databases, selecting studies comparing two or more different surgical treatments including Kirschner wire fixation and volar locking-plate fixation. This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methodological quality of all selected articles was assessed.

AREAS OF AGREEMENT

A total of 14 publications (1306 patients) were included in this review, 10 of which were prospectively designed (8 randomized controlled trial). A total of 659 (50.5%) patients underwent volar locking plating (VLP group), while 647 of 1306 (49.5%) were treated with Kirschner wire/pin fixation (KW group). No differences were recorded in terms of ROM, grip strength, radiographic variables and total rate of complications. There is no clear superiority of either fixation method for the surgical management of distal radius fractures.

AREAS OF CONTROVERSY

At a pooled analysis, VLP obtained statistically significant better DASH value compared to KW (18.1 ± 7.8 vs. 12.8 ± 6.4%, P = 0.026). Costs and surgical times were significantly higher for plate fixation.

GROWING POINTS

Both techniques provide excellent clinical and radiographic results, without a clear superiority of either fixation method for the surgical management of distal radius fractures.

RESEARCH

There is a need for more randomized trials performing standardized measurements at fixed follow-up, with results divided by subtypes of distal radius fractures.

Percutaneous Kirschner Wire fixation in distal radius metaphyseal fractures in children: does it change the overall outcome?

BACKGROUND AND OBJECTIVES

The aim of this study was to determine the effect of Kirschner wire fixation after closed reduction of radial metaphyseal fractures with high risk of redisplacement.

PATIENTS AND METHODS

In this retrospective study 40 cases were studied in two groups. In group 1 (n=20, average age 11.2 years), K-wire fixation was performed after closed reduction. In group 2 (n=20 average age 10.1 years), only plaster immobilization was applied following closed reduction. The compared clinical and radiological parameters were, pain, limb deformitiy, range of motion of the wrist, angulation of the fracture site, radial distal epipihyseal angle and severity of translation.

RESULTS

Redisplacement rate was 10% in group 1 and 50% in group 2. This shows, Kirschner wire fixation has a positive effect in the maintanence of the initial reduction (p<0.05). Age, gender, reduction quality had no effect on redisplacement (p>0.05). Concerning the severity of translation, the risk of redisplacement increases in stage 3 (50%- 100%) and stage 4 (>100%) fractures (p<0,05). Concomitant complete ulnar fracture has also redisplacement risk (p<0.05). Redisplacement risk increases when the distance of fracture line to epiphyseal line was between 11-20 mm (p<0.05). There was no significiant difference between two groups after last evaluation based on radiological parameters and clinical results (p>0.05).

CONCLUSIONS

This study shows that Kirschner wire fixation prevents redisplacement in early follow-up of first three weeks but there is no superiority after 20 months follow-up in distal metaphyseal fractures of children.

Extensor tendon injury to the index and middle finger secondary to Kirschner wire insertion for a distal radial fracture

We describe a case with the highly unusual complication of attritional ruptures to both the extensor tendons to the index and middle finger following Kirschner wire placements for a distal radial fracture. This particular complication has never been previously described in the literature. We also review the literature, identifying certain techniques in the management of distal radial fractures with Kirschner wires which are considered to increase the risk of tendonous or neurovascular injury. Finally, recommendations are made that should reduce the complications of iatrogenic soft tissue injury associated with this very common procedure.

Drilling K-wires, what about the osteocytes? An experimental study in rabbits

INTRODUCTION

The function of osteocytes regarding osteonecrosis has been underestimated for a long time. Recently it has been suggested that apoptosis of osteocytes results in strong osteoclastic bone resorption. Death of osteocytes due to drilling may therefore increase the risk of K-wire loosening. The purposes of our in vivo study were to assess the minimal drill time needed to notice disappearance of osteocytes and to measure the distance of the empty osteocyte lacunae surrounding the drill tract in relation with the insertion time, directly and 4 weeks after drilling Kirschner (K-) wires into the femur and tibia of rabbits.

MATERIALS AND METHODS

Trocar tipped K-wires (70 mm length and 0.6 mm thickness) were drilled into the femur and tibia of 14 New Zealand white rabbits [mean body weight 2.81 kg (2.66-3.09 kg)]. Six rabbits were terminated following surgery (t = 0) and eight rabbits were terminated 4 weeks (t = 4) after surgery. Following termination, hematoxylin and eosin stained sections were cut from femur and tibia until the drill hole was visible. The sections were evaluated under a light microscope for the presence or absence of osteocytes in osteocyte lacunae surrounding the drill holes.

RESULTS

All osteocyte lacunae were empty around the K-wires in 50 and 87% of the cases, directly and 4 weeks after the surgery, respectively. The osteocytes disappeared especially beyond a drilling time of 37 s (P = 0.011) and 27 s (P = 0.008) at t = 0 and t = 4, respectively. Furthermore, a significantly positive correlation was seen between the distances of the empty osteocyte lacunae surrounding the drill holes in relation with time at t = 0 (P = 0.008) and t = 4 (P = 0.000).

CONCLUSION

Although only drilling without cooling was studied, short drilling times may prevent the disappearance of osteocytes in case cooling is not used in clinical practice as is the case in percutaneous K-wire insertion.