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Legerstee IWF, Derksen BM, van der Oest MJW, Hundepool CA, Duraku LS, Selles RW, Michiel Zuidam J. Clinical outcomes after primary repair for thumb ulnar collateral ligament ruptures: a systematic review and meta-analysis. J Hand Surg Eur Vol 2024; 49:534-545. [PMID: 38488512 DOI: 10.1177/17531934241235556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.
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Affiliation(s)
- Ingmar W F Legerstee
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bas M Derksen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
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Rehm A, Linardatou Novak P, Newton AC, Clegg R, Ashby E. Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes? J Pediatr Orthop 2024; 44:e377-e378. [PMID: 38131353 DOI: 10.1097/bpo.0000000000002604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ayla C Newton
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachael Clegg
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Jones NJ, Zarook E, Ayub A, Manoukian D, Maizen C, Bijlsma P, Ramachandran M, Firth G. Postoperative Immobilization Period for Pediatric Supracondylar Fractures: The Shorter the Better? J Pediatr Orthop 2024; 44:203-207. [PMID: 38329322 DOI: 10.1097/bpo.0000000000002636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND There are now recognized standards of care published by the British and American Orthopaedic Associations which detail key areas of evidence-based recommendations for the treatment of children with displaced supracondylar humerus fractures. Although many aspects of treatment are covered in these recommendations, both the American and British Orthopaedic Associations do not recommend the exact duration of immobilization postoperatively. METHODS This study retrospectively compared outcomes of operatively managed supracondylar fractures immobilized postoperatively for short immobilization (SI) defined as 28 days or less, with long immobilization (LI) defined as more than 28 days. The outcomes measured were clinical (deformity, range of motion, and pin site infection) and radiologic (loss of position after the removal of K-wires, Baumann's angle, anterior humeral line, refracture, and signs of osteomyelitis). Demographic data were recorded to evaluate and ensure satisfactory matching of the 2 groups for analysis. RESULTS The study included 193 pediatric supracondylar fractures over a 4-year period which were treated with manipulation under anesthetic and K-wire fixation. The difference in average time in plaster between the 2 groups was statistically significant (SI: n=27.5 d, SD 1.23; LI: n=43.9 d, SD 15.29, P =0.0001). Data for operative techniques-closed or open reduction (SI: n=66, LI: n=78, P =0.59), and crossed wires (SI: n=37, LI: n=50, P =0.57) between the two groups showed no statistical significance. There was no statistical difference between the groups for the average number of days postoperatively at which wires were taken out (SI: n=28.9 d, SD 5.95, LI: n=30.1 d, SD 5.57, P =0.15), number of pin site infections requiring antibiotic treatment (SI: n=3, LI: n=5, P =0.70), or children from each group who were recorded to have regained full range of motion symmetrical to their contralateral arm (SI: n=79, LI: n=99, P =0.74). CONCLUSIONS Our study therefore suggests that shorter immobilization of these patients (SI group) does not yield a higher rate of complications including refracture and malunion.
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Affiliation(s)
| | - Essa Zarook
- Barts and The London School of Medicine and Dentistry, London, UK
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Del Chiaro A, Suardi C, Nucci AM, Grassi A, Pfanner S, Poggetti A. Choosing the proper implant for extra-articular fractures of proximal phalanges: A study on 75 cases. Injury 2024; 55:111441. [PMID: 38430751 DOI: 10.1016/j.injury.2024.111441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Phalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. MATERIAL AND METHODS We compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). RESULTS We found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DISCUSSION The surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. CONCLUSIONS In conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.
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Affiliation(s)
- A Del Chiaro
- 1st Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, Pisa, IT, Italy
| | - Chiara Suardi
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy.
| | - A M Nucci
- Paediatric Orthopaedic and Traumatology Department, Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - A Grassi
- 2nd Orthopaedic and Trauma Unit, IRCCS (Istituto Ortopedico Rizzoli), Via Di Barbiano, 1/10, Bologna, IT, Italy
| | - S Pfanner
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
| | - A Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
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Song YQ, Song RL, Ou YQ, Chen ZG. [Prefabricated curvature internal fixation with Kirschner needle for forearm fracture in children]. Zhongguo Gu Shang 2024; 37:311-5. [PMID: 38515421 DOI: 10.12200/j.issn.1003-0034.20230569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To explore clinical effect of precast curvature internal fixation with Kirschner needle in treating forearm fracture in children. METHODS From October 2019 to December 2022,32 children with forearm fractures were treated with precast curvature internal fixation with Kirkler's needles,including 25 males and 7 females,aged from 3 to 15 years old with an average of (8.0±0.5) years old,18 patients on the left side and 14 on the right side,24 patients with double fractures of radial and ulna,3 patients with Monteggia fractures,and 4 patients with Galeazzi fractures,and 1 patient with radial neck fracture of crooked cap. Operation time,intraoperative blood loss,C-arm fluoroscopy,fracture healing time and complications were recorded,and disabilities of arm,shoulder and hand (DASH) scale and Grace-Eversman forearm double fracture evaluation system were used to evaluate clinical efficacy of precast curvature internal fixation with Kirschner's needle for forearm fracture in children. RESULTS All 32 patients were followed up for 2 to 12 months with an average of (7.16±2.51) months. Intraoperative blood loss was (20.68±5.50) ml,C-arm fluoroscopy was(5.80±2.50),and operation time was (24.34±5.10) min,fracture healing time was (8.82±1.62) weeks. Two patients occurred complications,including postoperative rupture of extensor pollicis longus tendon in 1 patient and obvious displacement of fracture caused by rotation of prefabricated curvature Kirschler needle on bone marrow cavity in 1 patient. DASH scores ranged from 0 to 16 scores with an average of (8.32±1.50) scores. According to Grace-Eversman double fracture evaluation system,28 patients got excellent result,2 good and 2 fair. CONCLUSION The treatment of forearm fracture with Kirschner's needle prefabricated curvature internal fixation has advantages of less trauma,less bleeding,good reduction,stable fixation,fast fracture healing and good functional recovery.
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Affiliation(s)
- Yong-Qing Song
- Department of Orthopaedics, Song Zunxiu Memorial Hospital, Chenzhou 424100, Hunan, China
| | - Ru-Long Song
- Department of Orthopaedics, Song Zunxiu Memorial Hospital, Chenzhou 424100, Hunan, China
| | - Yi-Quan Ou
- Department of Orthopaedics, Song Zunxiu Memorial Hospital, Chenzhou 424100, Hunan, China
| | - Ze-Gang Chen
- Department of Orthopaedics, Song Zunxiu Memorial Hospital, Chenzhou 424100, Hunan, China
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Horoz L, Cakmak MF, Kircil C. Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique. BMC Musculoskelet Disord 2024; 25:228. [PMID: 38509566 PMCID: PMC10956287 DOI: 10.1186/s12891-024-07358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Surgical treatment of irreducible distal radius diaphyseal- metaphyseal junction fractures involves difficulties as the fracture remains too proximal for K-wire fixation and too distal for the elastic stable intramedullary nail. Our study aims to present the clinical results of applying an elastic stable intramedullary nail with a poller K-wire to achieve both reduction and stable fixation. PATIENTS AND METHODS A retrospective analysis was performed on 26 patients who underwent ESIN with a poller K-wire for distal radius diaphyseal-metaphyseal region fracture. Reduction parameters such as residual angulation and alignment were evaluated on postoperative follow-up radiographs. Changes in angular and alignment parameters on follow-up radiographs were recorded. Wrist and forearm functions were evaluated at the last follow-up. RESULT There were 17 male and nine female patients with an average age of 10.9. The residual angulation in coronal and sagittal planes on immediate postoperative radiographs was 4.0 ± 1.62° and 3.0 ± 1.26°, respectively. The mean translation rate on immediate postoperative radiographs was 6.0 ± 1.98% and 5.0 ± 2.02% in the coronal and sagittal planes, respectively. No change was observed in translation rates in the last follow-ups. The mean angulation in the coronal and sagittal planes measured on 6th-week radiographs was 4.0 ± 1.72°and 3.0 ± 1.16°, respectively. No significant difference was observed in angular changes in the sagittal and coronal planes at the last follow-up (p > 0.05). No tendon injury or neurovascular injury was observed in any of the patients. CONCLUSION In the surgical treatment of pediatric DRDMJ fractures, applying ESIN with poller K-wire is an effective, safe, and novel method for achieving reduction and stable fixation.
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Affiliation(s)
- Levent Horoz
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey.
| | - Mehmet Fevzi Cakmak
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey
| | - Cihan Kircil
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey
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Ma S, Zuo J, Hu Y. U-shaped kirschner wire transfixation: effective treatment for Skier's thumb. BMC Surg 2024; 24:91. [PMID: 38491501 PMCID: PMC10941620 DOI: 10.1186/s12893-024-02382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Skier's thumb is a type of injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which can result in bone fragmentation and joint instability. OBJECTIVE The objective of this study was to compare the traditional Kirschner wire fixation method with the U-shaped Kirschner wire method for treating small bone fragments with displacement, rotation, or instability in skier's fractures. METHOD A retrospective study was conducted on 30 patients with skier's thumb who were treated at Tianjin Hospital from January 2019 to December 2021. Patients were divided into two groups: Group A received traditional Kirschner wire fixation, while Group B received U-shaped Kirschner wire fixation. Functional assessments and complications during the perioperative period were evaluated. RESULTS Both surgical methods significantly reduced postoperative pain and increased joint range of motion. Group B had a lower incidence of pain during follow-up and showed significant functional improvement in Tip-pinch and Grip tests compared to Group A. U-shaped Kirschner wire fixation significantly reduced complications during the perioperative period. CONCLUSION The U-shaped Kirschner wire internal fixation is a safe and effective treatment for the thumb proximal phalanx base ulnar side avulsion fracture.
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Affiliation(s)
- Shuwei Ma
- Graduate School of Tianjin Medical University, No. 22 QiXiangTai Road, Heping District, Tianjin, 300070, P. R. China
| | - Jinzeng Zuo
- Graduate School of Tianjin Medical University, No. 22 QiXiangTai Road, Heping District, Tianjin, 300070, P. R. China
- The Second Hospital of Tangshan, Tangshan, 063000, Hebei, P. R. China
| | - Yongcheng Hu
- Department of Orthopaedic, Tianjin Hospital, Jiefang South Road, Hexi District, Hospital, Tianjin, 300211, P. R. China.
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Pawa S, Visuttiwattanakorn S. An in vitro study in separating tensile loads during maxillo-mandibular fixation using wire and/or elastics. PLoS One 2024; 19:e0300481. [PMID: 38489338 PMCID: PMC10942067 DOI: 10.1371/journal.pone.0300481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Intermaxillary fixation (IMF) or maxillo-mandibular fixation (MMF) is a fundamental process in stabilizing the maxilla and mandible through dental maximum intercuspation (MIP) during the management of trauma, orthognathic surgery, and reconstruction. Despite the availability of several techniques in achieving adequate maxillo-mandibular fixation, concerns have been raised regarding the sufficiency of using only latex elastics to counter displacing forces during reduction and fixation. To address this, an in vitro study was conducted to compare the efficacy of three maxillo-mandibular fixation methods: wire, elastics, and a combination of both. Custom-made models simulating dental arches were used, and a vertical separation of up to 1 mm was applied at a loading rate of 1 mm/minute using an Instron 5566 Universal Testing Machine. Tensile loads were recorded at 0.5 and 1 mm vertical separation, with each process repeated 10 times in each sample group. The average peak tensile load was then calculated. Statistical analysis using one-way ANOVA at a significance level of p<0.05 revealed significant differences between all three subject groups. The outcomes of this in vitro study suggest that the combination technique (using both wire and elastics) outperformed the individual methods in achieving robust maxillo-mandibular fixation. This positions the combination technique as the most effective among the evaluated fixation methods.
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Affiliation(s)
- Sudeep Pawa
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Surakit Visuttiwattanakorn
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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谢 康, 胡 子, 张 思, 贾 国, 金 斌, 褚 祥, 孙 军. [Comparative study of external fixator combined with Kirschner wire fixation and Kirschner wires fixation in treatment of cubitus varus deformity in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:284-289. [PMID: 38500420 PMCID: PMC10982039 DOI: 10.7507/1002-1892.202312045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Indexed: 03/20/2024]
Abstract
Objective To analyze the effectiveness comparison of external fixator combined with Kirschner wire fixation and Kirschner wire fixation in the treatment of cubitus varus deformity in children. Methods A retrospective case-control study was conducted to collect 36 children of postoperative supracondylar humerus fracture complicating cubitus varus deformity between January 2018 and July 2022. Among them, 17 cases were treated with distal humeral wedge osteotomy external fixation combined with Kirschner wire fixation (observation group), and 19 cases were treated with distal humeral wedge osteotomy and Kirschner wire fixation (control group). The baseline data including age, gender, deformity side, time from fracture to operation, carrying angle of the healthy side and preoperative carrying angle of the affected side, elbow flexion and extension range of motion, and lateral condylar prominence index (LCPI) showed no significant difference between the two groups ( P>0.05). The operation time, hospitalization cost, healing time of osteotomy, postoperative complications, and the carrying angle, LCPI, and elbow flexion and extention range of motion were recorded and compared between the two groups. The elbow function was assessed by Oppenheim score at 3 months after operation and at last follow-up. Results The children in both groups were followed up 13-48 months, with an average of 26.7 months. There was 1 case of needle tract infection in the observation group and 2 cases in the control group, and no nerve injury occurred, the difference in the incidence of complication (5.88% vs 10.53%) between the two groups was not significant ( χ 2=0.502, P=0.593). There was no significant difference in the operation time and fracture healing time between the two groups ( P>0.05); the hospitalization cost of the observation group was significantly higher than that of the control group ( P<0.05). The Oppenheim score of the observation group was significantly better than that of the control group at 3 months after operation ( P<0.05), but there was no significant difference in the Oppenheim score between the two groups at last follow-up ( P>0.05). At last follow-up, the carrying angle of affected side significantly improved in both groups when compared with preoperative ones ( P<0.05); the differences of the pre- and post-operative carrying angle of affected side and elbow flexion and extension range of motion showed no significant differences between the two groups ( P>0.05), but the difference in pre- and post-operative LCPI of the observation group was significantly better than that of the control group ( P<0.05). Conclusion External fixator combined with Kirschner wire fixation and Kirschner wire fixation both can achieve satisfactory correction of cubitus varus deformity in children, and the former can achieve better short-term functional recovery of elbow joint and reduce the incidence of humeral lateral condyle protrusion.
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Affiliation(s)
- 康 谢
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 子文 胡
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 思成 张
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 国强 贾
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 斌 金
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 祥军 褚
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 军 孙
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
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刘 朝, 贾 国, 黄 秀, 申 向, 姚 杰, 马 海. [Effectiveness comparison of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:278-283. [PMID: 38500419 PMCID: PMC10982031 DOI: 10.7507/1002-1892.202312018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/27/2024] [Indexed: 03/20/2024]
Abstract
Objective To compare the effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation for different unstable humeral lateralcondylar fractures of children. Methods The clinical data of 94 children with unstable humeral lateralcondylar fractures admitted to three medical centers between January 2021 and October 2022 were retrospectively analyzed. The children were divided into three groups according to the Song classification and whether the elbow joint was dislocated or not, including 42 cases of Song 4 type (group A), 38 cases of Song 5 type (group B), and 14 cases of elbow joint dislocation (group C). There was no significant difference in gender, age, side, cause of injury, and time from injury to operation among the three groups ( P>0.05). All children were treated with ultrasound-guided closed reduction and Kirschner wire fixation. The operation time and complications of the three groups were recorded and compared, and the failure of closed reduction was evaluated by ultrasound. X-ray examination was performed at last follow-up to measure the Baumann angle, condylar angle, carrying angle, and lateral osteophyte of the affected side; the extension, flexion, pronation, and supination range of motion of the affected elbow joint were measured; the function of the elbow joint was evaluated by Mayo score. Results The operation time in group A was significantly longer than that in groups B and C ( P<0.05). There were 7, 2, and 5 cases of closed reduction failure in groups A, B, and C, respectively, and there was no significant difference in the incidence of the closed reduction failure ( P>0.05). All patients were followed up 6-28 months, with an average of 15.7 months. There was no significant difference in the follow-up time among the three groups ( P>0.05). Complications: in group A, there were 2 cases of delayed union, 4 cases of needle tract infection, 1 case of trochlear necrosis, and 39 cases of lateral osteophyte; in group B, there was 1 case of malunion, 5 cases of needle tract infection, 1 case of redisplacement, and 26 cases of lateral osteophyte; in group C, there were 2 cases of needle tract infection and 10 cases of lateral osteophyte. There was no significant difference in the incidence of complications among the three groups ( P>0.05). No cubitus varus or cubitus valgus deformity was found in all patients. At last follow-up, except that the condylar angle in group A was significantly greater than that in groups B and C ( P<0.05), there was no significant difference in other imaging indicators, elbow range of motion, or Mayo score between groups ( P>0.05). Conclusion The Song type 4 of humeral lateralcondylar fracture treated with ultrasound-guided closed reduction and Kirschner wire fixation has a longer operation time, more postoperative complications, and is more prone to lateral osteophyte.
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Affiliation(s)
- 朝宇 刘
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - 国强 贾
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - 秀明 黄
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - 向阳 申
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - 杰 姚
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
| | - 海龙 马
- 安徽医科大学附属阜阳市人民医院骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University, Fuyang Anhui, 236000, P. R. China
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Kook I, Park KC, Kim KY, Jung I, Hwang KT. Efficacy of Minimally Invasive Reduction With Cerclage Fixation in Spiral or Oblique Subtrochanteric Femoral Fractures: A Retrospective Cohort Study Comparing Cables and Wires. J Orthop Trauma 2024; 38:160-167. [PMID: 38098139 DOI: 10.1097/bot.0000000000002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To compare the outcomes of a minimally invasive reduction (MIR) technique using a cable and wire in spiral or oblique subtrochanteric femoral fractures (SFFs). METHODS DESIGN Retrospective cohort study. SETTING Two University Hospitals. PATIENT SELECTION CRITERIA Skeletally mature patients with spiral or oblique SFFs (OTA/AO 32A1 and 32A2) treated with intramedullary nailing and MIR with a cerclage wire passer using either a single-loop cable or cerclage wire or MIR without cable or wire between May 2016 and November 2021 were included. OUTCOME MEASURES AND COMPARISONS Coronal and sagittal interfragmentary gap, neck-shaft angle, coronal and sagittal angulation, fracture union, time to union, and Radiographic Union Score for Hip (RUSH) at 6 months post operation were compared. RESULTS A total of 46 patients were included, with 16 each in the cable and wire groups and 14 in the non-wiring group. There were no differences in demographics ( P > 0.05), fracture classification ( P = 0.710), or operative data ( P > 0.05) between the three groups. The cable group showed significantly better coronal ( P = 0.003) and sagittal ( P = 0.003) interfragmentary gap, shorter union time ( P < 0.001), and higher 6-month RUSH score ( P < 0.001) among the three groups. There were no significant differences in outcome measures between the wire and non-wiring groups (all P > 0.05). No mechanical complications or reoperations were observed in all three groups. CONCLUSIONS Minimally invasive reduction using a cable is more effective than wire or non-wiring reduction to improve reduction quality and promote bone union in the SFFs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Incheol Kook
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea ; and
| | - Ki-Chul Park
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Gyeonggi-do, Korea
| | - Keong Yoon Kim
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea ; and
| | - Ilyun Jung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea ; and
| | - Kyu Tae Hwang
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea ; and
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12
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Mateen S, Raja S, Casciato DJ, Siddiqui NA. Minimally Invasive Versus Open Hammertoe Correction: A Retrospective Comparative Study. J Foot Ankle Surg 2024; 63:156-160. [PMID: 37806485 DOI: 10.1053/j.jfas.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
Hammertoe deformity is a common forefoot pathology, characterized by a progressive deformity with dorsiflexion of the proximal phalanx on the metatarsal head at the metatarsal phalangeal joint (MTPJ) and plantarflexion of the intermediate phalanx on the proximal phalanx at the proximal interphalangeal joint (PIPJ). While there is literature available discussing open techniques for hammertoe correction, there is a lack of publications discussing minimally invasive techniques, therefore the objective of this retrospective comparative study is to evaluate minimally invasive versus open hammertoe surgery in terms of time to osseous union, complications, recurrence, and return to full activity. Sixty eight feet among 41 patients met the inclusion criteria and were surveyed. Among the 68 feet, 54 feet (124 toes) underwent minimally invasive hammertoe correction and 14 feet (22 toes) underwent open hammertoe correction. Time to osseous union (weeks) in the MIS group was 8.76 ± 2.31 weeks with similar outcomes to the open group with union at 8.42 ± 2.31 (p = .65). Return to activity (weeks) was 10.47 ± 3.45 in the MIS group and 9.92 ± 3.03 in the open group with no statistical significance (p = .62). There was 4 recurrent hammertoe deformities in the MIS group (3.23%) with no recurrent hammertoes in the open group (0%). In the MIS group 5 hammertoes had unplanned hardware removal (4.03%) compared to 0 in the open group. There was no statistical significance for both recurrence and unplanned hardware removal (p = 1). Overall, we concluded that both techniques are equivocal with no detectable statistical difference.
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Affiliation(s)
- Sara Mateen
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Shehryar Raja
- Resident, Rubin Institute for Advanced Orthopedics/VA Maryland Health Care System Podiatric Residency Program, Baltimore, MD
| | - Dominick J Casciato
- Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Noman A Siddiqui
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; Director, Podiatric Surgery, International Center for Limb Lengthening, Baltimore, MD; Director, Foot and Ankle Deformity Correction and Orthoplastics Fellowship, Baltimore, MD; Chief of Podiatry, Sinai and Northwest Hospitals, Baltimore, MD.
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13
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Crook JL, Pientka W, Zhang AY, Golden A, Koehler D, Sammer D. Risk factors for surgical site infection after surgical treatment of closed distal radial fractures. J Hand Surg Eur Vol 2024; 49:310-315. [PMID: 37666217 DOI: 10.1177/17531934231194672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
We assessed operatively treated closed distal radial fractures to identify independent risk factors for surgical site infection after treatment. A retrospective review was carried out of 531 operatively treated closed distal radial fractures over a 5-year period. Multiple logistic regression was performed with infection as the dependent variable, using a stepwise regression procedure to select variables to construct the final model. In total, 19 (3.6%) fractures were complicated by postoperative surgical site infection. Uncontrolled diabetes with HbA1c >7, the presence of external fixation or external Kirschner wires, and tobacco use were significant independent predictors of infection. Age and time in the operating room were also statistically significant predictors but deemed to be not clinically meaningful.Level of evidence: IV.
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Affiliation(s)
- Jennifer L Crook
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - William Pientka
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX, USA
| | - Andrew Y Zhang
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Daniel Koehler
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Douglas Sammer
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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14
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Casciato DJ, Mateen S, Wynes J. "No Care Pin Care" Following Charcot Reconstruction With Static External Fixation. J Foot Ankle Surg 2024; 63:237-240. [PMID: 38043598 DOI: 10.1053/j.jfas.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Charcot reconstruction with static external fixation provides stability in deformity correction. Concern for pin site health remains forefront to prevent premature fixator removal should infection develop. While previous investigations examined a spectrum of pin care protocol with a similar variation in outcomes, this study assesses results following a "no care pin care" routine. A retrospective analysis of patients with Charcot neuroarthropathy treated with static external fixation was performed where all pin sites were dressed using a chlorhexidine-soaked sponge without postoperative maintenance. Demographics, reconstruction-specific, and postoperative variables including pin site irritation, pin site infection, and pin tract infection were collected through frame removal. A comparison between uncomplicated and complicated pin sites was made. Statistical significance was set as p ≤ .05. Among 85 patients and their respective pin holes that posed potential spots of infection, 6 (7%) experienced pin site irritation and 5 (6%) experienced pin site infection. Moreover, 2 (2%) experienced a pin tract infection requiring removal. Out of the 768 wires/half-pins 2 (0.3%) were removed. There existed no statistically significant predictors of pin site irritation/infection other than age (p = .03). "No care pin care" proves an effective means at pin site care following static external fixation in Charcot reconstruction. Limited maintenance reduces the postoperative burden on providers and patients.
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Affiliation(s)
- Dominick J Casciato
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD.
| | - Sara Mateen
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Jacob Wynes
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD
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15
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Zhang F, Zhao T, Liu Y, Dai J, Liu Y, Liu W, Wang X, Zhen Y. Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children. J Pediatr Orthop B 2024; 33:174-177. [PMID: 36943689 PMCID: PMC10829901 DOI: 10.1097/bpb.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC. There were no significant differences between PKRC and PKRNC with regard to preoperative angulation ( P = 0.556). The operation time in the PKRC group was significantly shorter than that of the PKRNC group ( P = 0.023). There was no significant difference in the displacement angle when compared between the two groups on the first day and 1 month after surgery ( P = 0.617, 0.72). The Mayo elbow performance score of the elbow joint function did not differ significantly between the two groups ( P = 0.587). Although the hospital stay was not significantly different between groups (4.81 ± 1.07 vs. 4.16 ± 1.59 days; P = 0.067), the PKRNC group required a second hospitalization to remove the elastic intramedullary nail 3 months after the operation. PKRC and PKRNC both achieved satisfactory outcomes for radial neck fractures in children. The operation time in the PKRC group was significantly lower than in the PKRNC group. PKRC does not require reoperation to remove internal fixation. Therefore, PKRC is recommended for radial neck fractures in children.
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Affiliation(s)
- Fuyong Zhang
- Department of Orthopaedics, Children’s Hospital of Soochow University
| | - Tantan Zhao
- Department of Orthopaedics, Wujiang Children’s Hospital, Suzhou, China
| | - Ya Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University
| | - Jin Dai
- Department of Orthopaedics, Wujiang Children’s Hospital, Suzhou, China
| | - Yao Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University
| | - Wendong Liu
- Department of Orthopaedics, Children’s Hospital of Soochow University
| | - Xiaodong Wang
- Department of Orthopaedics, Children’s Hospital of Soochow University
| | - Yunfang Zhen
- Department of Orthopaedics, Children’s Hospital of Soochow University
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16
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Wegmann S, Hackl M, Krane F, Wegmann K, Mueller LP, Leschinger T. Accessibility of osteochondral lesion at the capitellum during elbow arthroscopy: an anatomical study. Arch Orthop Trauma Surg 2024; 144:1297-1302. [PMID: 38172435 PMCID: PMC10896769 DOI: 10.1007/s00402-023-05172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) at the capitellum is a common pathology in young patients. Although arthroscopic interventions are commonly used, there is a lack of information about the accessibility of the defects during elbow arthroscopy by using standard portals. MATERIALS AND METHODS An elbow arthroscopy using the standard portals was performed in seven fresh frozen specimens. At the capitellum, the most posterior and anterior cartilage surface reachable was marked with K-wires. Using a newly described measuring method, we constructed a circular sector around the rotational center of the capitellum. The intersection of K-wire "A" and "B" with the circular sector was marked, and the angles between the K-wires and the Rogers line, alpha angle for K-Wire "A" and beta angle for K-wire "B", and the corridor not accessible during arthroscopy was digitally measured. RESULTS On average, we found an alpha angle of 53° and a beta angle of 104°. Leaving a sector of 51° which was not accessible via the standard portals during elbow arthroscopy. CONCLUSION Non-accessible capitellar lesions during elbow arthroscopy should be considered preoperatively, and the informed consent discussion should always include the possibility of open procedures or the use of flexible instruments. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- S Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - M Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Krane
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Wegmann
- OCM (Orthopädische Chirurgie München) Clinic, Steinerstr. 6, 81369, Munich, Germany
| | - L-P Mueller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - T Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Rehm A, Linardatou Novak P, Newton A, Ngu AWT, Clegg R, Ashby E. Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques. Injury 2024; 55:111354. [PMID: 38246014 DOI: 10.1016/j.injury.2024.111354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Pinelopi Linardatou Novak
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ayla Newton
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Albert W T Ngu
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rachael Clegg
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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18
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Liu CD, Hu SJ, Chang SM, Du SC, Chu YQ. Morphological characteristics and a new classification system of the inferior pole fracture of the patella: A computer-tomography-based study. Injury 2024; 55:111256. [PMID: 38049367 DOI: 10.1016/j.injury.2023.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The objective of this study was to measure the morphological characteristics of inferior pole fracture of the patella (IPFP) and develop a practical classification system to determine the corresponding treatment protocols for different IPFPs with specific patterns. METHODS A retrospective radiographic review was performed on a series of 71 patients with IPFP. The preoperative CT data were collected and measured using image processing software. The number of fragments, maximum fracture fragment anteroposterior length (MFFAL), maximum fracture fragment transverse length (MFFTL), fracture fragment coronal angle (FFCA), fracture fragment sagittal angle (FFSA), maximum fracture fragment height (MFFH) and maximum transverse sectional area (MTSA) were analysed. RESULTS The mean number of fracture fragments was 3.8. The average MFFAL was 14.9 mm, the average MFFTL was 23.5 mm, the average FFCA was 92.1°, the average FFSA was 93.0°, the average MFFH was 13.6 mm, and the average MTSA was 299.3 mm2. A new classification system was introduced to describe the varied patterns of IPFP, summarized as (I) simple IPFP; (II) comminuted IPFP; (III) simple IPFP with simple patellar body fracture; and (IV) comminuted patellar fracture involving the inferior pole. With the four-type classification system, 12 type I, 22 type II, 21 type III, and 16 type IV lesions were observed, each with specific morphological characteristics. CONCLUSION Most IPFPs exhibited a diversiform pattern, demonstrating that coverage fixation was likely needed. The four-type classification system might offer a valuable approach to help orthopaedic surgeons make individual treatment plans.
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Affiliation(s)
- Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Sun-Jun Hu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China.
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Yong-Qian Chu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
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Wang H, Wang D, Huang S, Li W, Tan L, Wu H, Pei X. Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture. J Pediatr Orthop B 2024; 33:184-191. [PMID: 37401488 PMCID: PMC10829904 DOI: 10.1097/bpb.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children's Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman's rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.
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Affiliation(s)
- Huaikeng Wang
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
| | - Dahui Wang
- Department of Orthopaedics Surgery, Children’s Hospital of Fudan University, Shanghai, China
| | - Shaomin Huang
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
| | - Wanting Li
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
| | - Lujian Tan
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
| | - Haiyi Wu
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
| | - Xinhong Pei
- Department of Orthopaedics Surgery, Xiamen Hospital, Children’s Hospital of Fudan University, Fujian Province
- Department of Orthopaedics Surgery, Children’s Hospital of Fudan University, Shanghai, China
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Popa A, Pineda A, Akhter M. Thromboembolic stroke from aberrant sternotomy wire. Intern Emerg Med 2024; 19:581-582. [PMID: 38012366 DOI: 10.1007/s11739-023-03452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Andreea Popa
- Department of Emergency Medicine, HCA Florida Kendall Regional Medical Center, Miami, FL, USA
| | - Ana Pineda
- Department of Emergency Medicine, HCA Florida Kendall Regional Medical Center, Miami, FL, USA
| | - Murtaza Akhter
- Department of Emergency Medicine, HCA Florida Kendall Regional Medical Center, Miami, FL, USA.
- Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, 85004, USA.
- Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
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21
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Xiao Y, Clement A, Kang C, Ren B, Liu X. Kirschner Wire Prying and Leverage Technique: a new closed reduction method in treatment of pediatric "Irreducible Supracondylar Humerus Fractures". J Orthop Surg Res 2024; 19:113. [PMID: 38308347 PMCID: PMC10837941 DOI: 10.1186/s13018-024-04592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND This study employs an innovative closed reduction approach to treat pediatric "Irreducible Supracondylar Humerus Fractures" with the goal of demonstrating its practical application compared to conventional methods. METHODS This study sampled 146 surgically treated cases of "Irreducible Supracondylar Humerus Fractures" in our department. After applying inclusion and exclusion criteria, 120 children were selected and divided into two groups based on treatment methods. Group 1 underwent Closed Reduction and Percutaneous Pinning (CRPP), while Group 2 received treatment using the Kirschner Wire Prying and Leverage Technique alongside CRPP. The relevant data to the study were collected and assessed during the follow-up period. RESULTS Results indicate that Group 2 demonstrated significantly shorter operative times and fewer instances of intraoperative fluoroscopy compared to Group 1. Furthermore, the percentage of cases requiring open reduction was notably higher in Group 1 than in Group 2. The analysis also identified age, BMI, time from injury to surgery, and the initial deviation of the distal fragment as independent risk factors associated with the failure of closed reduction. The integration of CRPP with the Kirschner Wire Prying and Leverage Technique emerges as a safe and effective strategy for managing "Irreducible Supracondylar Humerus Fractures." This innovative approach not only reduces operative time and intraoperative fluoroscopy needs but also diminishes the reliance on open reduction without compromising safety.
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Affiliation(s)
- Yuan Xiao
- Department of Pediatric Orthopaedics, Sichuan Provincial Orthopaedic Hospital, No. 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
| | - Arthur Clement
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Chi Kang
- Department of Pediatric Orthopaedics, Sichuan Provincial Orthopaedic Hospital, No. 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
| | - Bo Ren
- Department of Pediatric Orthopaedics, Sichuan Provincial Orthopaedic Hospital, No. 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
| | - Xin Liu
- Department of Pediatric Orthopaedics, Sichuan Provincial Orthopaedic Hospital, No. 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China.
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Del Piñal F, Williams DC, Rúas JS, Lim JX, Studer A. The stacking concept: cannulated screws for extra-articular metacarpal base fracture of the thumb. J Hand Surg Eur Vol 2024; 49:264-266. [PMID: 37882767 DOI: 10.1177/17531934231203165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
An alternative technique to treat extra-articular fractures of the base of the first metacarpal with intramedullary canulated headless screws is presented. The principle is creating an internal fixator within the medullary canal by introducing multiple retrograde screws until they have jammed.
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Affiliation(s)
| | - Daniel C Williams
- Hand Surgery, Private Practice, Madrid, Spain
- Currently Griffith University School of Medicine and Dentistry, Queensland, Australia
| | | | - Jin Xi Lim
- Hand Surgery, Private Practice, Madrid, Spain
- Currently Department of Hand and Reconstructive Microsurgery, National University, Singapore
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23
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Kim KI, Kim JH, Son G. Comparison of Fixation Methods Between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis. J Orthop Trauma 2024; 38:e63-e70. [PMID: 38031280 DOI: 10.1097/bot.0000000000002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To compare, in a systematic review, Krakow transosseous (KT) suturing and separate vertical wiring (VW) fixation methods in inferior pole fractures of the patella and to evaluate whether the supplementary fixation affected bone union. METHODS DATA SOURCES The MEDLINE, Embase, and Cochrane databases were searched from inception to January 15, 2023. The keywords were "patella inferior pole fracture", "patella distal pole fracture", "transosseous", "pull-out suture", "reattachment", and "vertical wiring". STUDY SELECTION All clinical studies describing KT or VW techniques for inferior pole fracture of the patella and reporting bone union-related complications were included. DATA EXTRACTION This meta-analysis included 16 studies with 274 patellae. Demographic data, surgical techniques, clinical outcomes, and complication rates were recorded. The Methodological Index for Non-Randomized Studies criteria were used to assess their quality. DATA SYNTHESIS A meta-analysis was performed using random-effects models and meta-regression. The meta-analytic estimate of bone union-related complications was 3.8% (95% CI, 1.6%-6.0%) for either PO or VW techniques in inferior pole fractures of the patella. The bone union-related complication rates did not differ significantly between the two techniques (KT, 5.7%; VW, 3.0%; P = .277). Meanwhile, supplementation fixation was significantly associated with decrease in bone union-related complication rates ( p = .013). CONCLUSIONS Fixation of inferior pole fractures of the patella using either KT or VW techniques provided satisfactory and similar clinical results with minimal bone union-related complications. Supplementary fixation has a positive impact on reducing bone union-related complications in inferior pole fractures of the patella following KT and VW techniques. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; and
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; and
| | - Gwankyu Son
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; and
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24
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Bulut T, Eroglu ON, Husemoglu B, Onder Y, Turgut A. Comparison of antegrade and retrograde cross pin fixation in the surgical treatment of pediatric supracondylar femur fractures: A biomechanical study. Injury 2024; 55:111284. [PMID: 38141389 DOI: 10.1016/j.injury.2023.111284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE The aim of this study is to compare biomechanical stability of Kirschner wires (K-wires) sent with antegrade and retrograde technique in the fixation of pediatric supracondylar femur fractures. MATERIALS AND METHODS A transverse fracture model was created two centimeters above the physis in 24 synthetic bone models suitable for the pediatric femur bone structure. The models were randomly divided into two groups as 12 bones each. In the first group (Group 1), 12 bone fracture models were retrogradely fixed with two cross K-wires. In the second group (Group 2), the fracture was fixed antegradely. In Group 2, both wire ends were allowed to protrude three millimeters from the femoral condyles. The stability of the groups was tested biomechanically by exposing them to varus and extension forces. The forces corresponding to 1 mm, 2 mm, 3 mm and 4 mm displacement and failure loads were calculated in two groups. RESULTS According to the test results regarding displacements and failure loads, the retrograde group was found to be significantly stronger than the antegrade group against varus loads (p < 0.05). When the groups were compared in terms of extension strength, the results of the two groups were similar and there was no statistical difference between them (p > 0.05). CONCLUSION Retrograde cross K-wires fixation provides a more stable fixation against varus forces. This is important to prevent varus deformity, which is a clinically less tolerable deformity. However, considering that full-weight mobilization of patients is not allowed after surgery in pediatric supracondylar femur fractures, the surgeon should consider that K-wires can also be sent antegrade to decrease the risk of septic arthritis.
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Affiliation(s)
- Tugrul Bulut
- Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Orthopaedics and Traumatology, Izmir, Turkey.
| | - Osman Nuri Eroglu
- Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Orthopaedics and Traumatology, Izmir, Turkey
| | - Bugra Husemoglu
- Dokuz Eylul University, Institute of Health Science, Department of Biomechanics, Izmir, Turkey
| | - Yilmaz Onder
- Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Orthopaedics and Traumatology, Izmir, Turkey
| | - Ali Turgut
- Health Sciences University, Tepecik Training and Research Hospital, Department of Orthopaedics and Traumatology, Izmir, Turkey
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25
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Bhumiwat P, Fossum BW, Dey Hazra RO, Ganokroj P. Treatment of Unfixable Inferior Pole Fractures of the Patella Using an All-Suture Internal Fixation Technique. Clin Orthop Surg 2024; 16:168-172. [PMID: 38304204 PMCID: PMC10825245 DOI: 10.4055/cios23111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 02/03/2024] Open
Abstract
Inferior pole fractures of the patella are a type of patellar fracture that has various complexities. Most current techniques are associated with hardware-related complications, which is one of the main concerns when treating this complex fracture. We present a new technique that does not require metal implant removal, causes little to no irritation of the quadriceps muscle, and provides strong fixation that allows for early range of motion postoperatively.
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Affiliation(s)
- Pongpak Bhumiwat
- Department of Orthopaedic Surgery, Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Phob Ganokroj
- Department of Orthopaedic Surgery, Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Steadman Philippon Research Institute, Vail, CO,
USA
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26
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Clutton JM, Kinghorn AF, Trickett RW. Does Dressing Choice Affect Infection Rate in Percutaneous K-Wiring of the Hand and Wrist? - A Systematic Review. J Hand Surg Asian Pac Vol 2024; 29:3-11. [PMID: 38299244 DOI: 10.1142/s2424835524500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire's ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature. Methods: An electronic search was carried out across multiple databases. Abstracts were screened by two independent reviewers against inclusion criteria and, where necessary, full texts were reviewed. Nine eligible papers were identified, and data regarding type of procedure, dressing choice and infection rate was extracted. Results: The included studies were widely heterogenous, and the standard of the evidence was, in general, poor. In most, dressing choice and infection incidence were not the primary intervention/outcome under study. Conclusions: Based on the available literature, insufficient evidence exists to establish one dressing choice as having a lower infection rate. This highlights the need for further high-quality evidence in this area. Level of Evidence: Level III (Therapeutic).
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27
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Mattioli DD, Thomas GW, Long S, Rölfing JD, Anderson DD. Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill. J Orthop Res 2024; 42:404-414. [PMID: 37652571 DOI: 10.1002/jor.25685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/05/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
Psychomotor skill and decision-making efficiency in surgical wire navigation can be objectively evaluated by analysis of intraoperative fluoroscopic image sequences. Prior work suggests that such image-based behavior analysis of operating room (OR) performance can predict performer experience level (R2 = 0.62) and agree with expert opinion (the current standard) on the quality of a final implant construct (R2 = 0.59). However, it is unclear how objective image-based evaluation compares with expert assessments for entire technical OR performances. This study examines the relationships between three key variables: (1) objective image-based criteria, (2) expert opinions, and (3) performing surgeon experience level. A paired-comparison survey of seven experts, based upon eight OR fluoroscopic wire navigation image sequences, shows that the experts' preferences are best explained by objective metrics that reflect psychomotor and decision-making behaviors which are counter-productive to successful implant placement, like image count (R2 = 0.83) and behavior tally (R2 = 0.74). One such behavior, adjustments away from goal, uniquely correlated well with all three key variables: a fluoroscopic image-based analysis composite score (R2 = 0.40), expert consensus (R2 = 0.76), and performer experience (R2 = 0.41). These results confirm that experts view less efficient technical behavior as indicative of lesser technical proficiency. While expert assessments of technical skill were reliable and consistent, neither individual nor consensus expert opinion appears to correlate with performer experience (R2 = 0.11).
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Affiliation(s)
- Dominik D Mattioli
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Geb W Thomas
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Steven Long
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Jan Duedal Rölfing
- Children's Orthopaedics and Reconstruction, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Corporate HR, MidtSim, Aarhus, Denmark
| | - Donald D Anderson
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
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28
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Dagi AF, Hong DY, Strauch RJ. Extra-Articular Base Fractures of the Proximal Phalanx in Adults: A Systematic Review. J Hand Surg Asian Pac Vol 2024; 29:49-58. [PMID: 38299241 DOI: 10.1142/s2424835524500085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Extra-articular proximal phalanx base fractures are common in adults and can lead to permanent finger stiffness and joint contractures. The purpose of this review is to summarise the evidence for operative and non-operative management of this fracture type. Methods: The MedLine, Embase, PubMed, Scopus and Cochrane Library databases were searched using the following key terms: 'proximal phalanx', 'base', 'fracture', 'repair' and 'fixation'. A total of 2,889 unique records were extracted. All studies with primary data on the management of extra-articular proximal phalangeal base fractures in adults were included for initial review. Results: Eleven studies met inclusion criteria with a total of 441 extra-articular proximal phalanx base fractures. Outcomes were determined by final total active range of motion. 182 extra-articular proximal phalangeal base fractures were treated non-operatively, with excellent or good outcomes attained in 80% of cases. Another 259 extra-articular proximal phalangeal base fractures were treated operatively, including 236 with Kirschner wires (K-wires), 18 with plates, and five with intramedullary screws. Case-level data were available in 186 fractures managed by K-wire fixation, with excellent or good outcomes achieved in 79% of cases. Excellent or good outcomes were achieved in 35% of cases treated by plates, and 80% of five cases treated by intramedullary screw fixation. Three (1.6%) patients managed conservatively required surgery after reduction loss. No patients managed with K-wires required re-operation for reduction loss; tenolysis/capsulotomy was required in 11 (4.5%) cases for stiffness, and pin site infections occurred in eight (3.5%) cases. Complex regional pain syndrome occurred in five cases (28%) of plate fixation. Conclusions: In summary, excellent or good results may be achieved by K-wire pinning or conservative management. Current evidence is limited for plate or intramedullary screw fixation. Prospective trials and outcomes standardisation are needed to improve the evidence base. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Alexander F Dagi
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
| | - Daniel Y Hong
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
| | - Robert J Strauch
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
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29
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Lin Y, Hua Z, Zhou C, Chen S, Sun X, Liu F, Meng G, Zhang S, Sun J. A new technique of intramedullary elastic reduction of the "de-sharpened" Kirschner wire for the treatment of Gartland type III posterolateral displaced supracondylar fracture of the humerus in children. Eur J Med Res 2024; 29:87. [PMID: 38291485 PMCID: PMC10826127 DOI: 10.1186/s40001-024-01671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To compare the clinical effects of intramedullary elastic reduction of the "de-sharpened Kirschner wire and traditional three-dimensional manipulation in the treatment of Gartland type III posterolateral supracondylar fracture of the humerus in children. METHODS A retrospective cohort analysis was made on 106 cases of Gartland type III posterolateral supracondylar fracture of the humerus treated in the Department of Orthopaedics of a Children's Hospital from March 2020 to March 2022. According to different surgical technology, the patients were divided into two groups: intramedullary elastic reduction of the de-sharpened Kirschner wire group (experimental group, n = 50) and traditional three-dimensional manipulation group (control group, n = 56). The surgical operating time, intraoperative fluoroscopy times, postoperative Baumann angle changes, postoperative elbow function Flynn score, and complications were collected and compared between the two groups. RESULTS All the enrolled cases underwent surgery successfully and were followed-up at least 6 months. The surgical operating time of the experimental group was 32.88 ± 3.69 min and that of the control group was 45.56 ± 10.13 min, and the difference was statistically significant (P < 0.05). The intraoperative fluoroscopy times were 20.62 ± 5.41 times in the experimental group and 32.48 ± 8.20 times in the control group (P < 0.05). The change of Baumann angle in the experimental group after operation was 2.3 ± 1.3 and that in the control group was 6.0 ± 2.1 (P < 0.5). Elbow joint Flynn scoring standard to evaluate the curative effect: the excellent and good rate was 98.00% (49/50) in the experimental group and 92.86% (52/56) in the control group (P > 0.5). There were no complications such as osteomyelitis, compartment syndrome, iatrogenic vascular and nerve injury, and myositis ossificans in either group. CONCLUSIONS Good functional outcome can be obtained with both intramedullary elastic reduction of the de-sharpened Kirschner wire and traditional three-dimensional manipulation for Gartland type III posterolateral displaced supracondylar fracture of the humerus in children; however, the former does not need repeated manipulation, and the operation time is shorter, the number of intraoperative fluoroscopy is less, and the recovery of the Baumann angle is better.
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Affiliation(s)
- Yudong Lin
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Zhongtuo Hua
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Cheng Zhou
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Saiwen Chen
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Xiwei Sun
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Fang Liu
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Ge Meng
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Sicheng Zhang
- Anhui Provincial Children's Hospital, Hefei, China
- The Fifth Clinical College of Anhui Medical University, Hefei, China
| | - Jun Sun
- Anhui Provincial Children's Hospital, Hefei, China.
- The Fifth Clinical College of Anhui Medical University, Hefei, China.
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30
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Kim S, Mungalpara N, Wangikar R, Tarabichi M, Karam J, Bedi A, Koh J, Amirouche F. Comparative study of locking neutralization plate construct versus tension band wiring with a cannulated screw for patella fractures: experimental and finite element analysis. J Orthop Surg Res 2024; 19:77. [PMID: 38233950 PMCID: PMC10795423 DOI: 10.1186/s13018-024-04538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
Transverse patella fractures, accounting for approximately 1% of Orthopedic injuries, pose intricate challenges due to their vital role in knee mechanics. This study aimed to compare the biomechanical performance of a construct, integrating cannulated screws and an anterior locking neutralization plate, with the conventional tension band wiring technique for treating these fractures. Experimental testing and Finite Element Analysis were employed to evaluate the constructs and gain profound insights into their mechanical behavior. Sixteen cadaveric knees were prepared, and transverse patella fractures were induced at the midpoints using a saw. The plate construct and tension band wire fixation were randomly assigned to the specimens. A cyclic test evaluated the implants' durability and stability, simulating knee movement during extension and flexion. Tensile testing assessed the implants' maximum failure force after cyclic testing, while Finite Element Analysis provided detailed insights into stress distribution and deformation patterns. Statistical analysis was exclusively performed for the experimental data. Results showed the plate enhanced stability with significantly lower deformation (0.09 ± 0.12 mm) compared to wire fixation (0.77 ± 0.54 mm) after 500 cycles (p = 0.004). In tensile testing, the construct also demonstrated higher failure resistance (1359 ± 21.53 N) than wire fixation (780.1 ± 22.62N) (p = 0.007). Finite Element Analysis highlighted distinct stress patterns, validating the construct's superiority. This research presents a promising treatment approach for transverse patella fractures with potential clinical impact and future research prospects. This study presents a promising advancement in addressing the intricate challenges of transverse patella fractures, with implications for refining clinical practice. The construct's improved stability and resistance to failure offer potential benefits in postoperative management and patient outcomes.
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Affiliation(s)
- Sunjung Kim
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nirav Mungalpara
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Rohan Wangikar
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Majd Tarabichi
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Joseph Karam
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Asheesh Bedi
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Jason Koh
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Farid Amirouche
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA.
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31
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李 波, 张 世, 胡 孙, 杜 守, 熊 文. [Research progress on valgus impacted proximal humeral fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:107-112. [PMID: 38225849 PMCID: PMC10796224 DOI: 10.7507/1002-1892.202308062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024]
Abstract
Objective To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF). Methods The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized. Results PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option. Conclusion Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.
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Affiliation(s)
- 波 李
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 世民 张
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 孙君 胡
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 守超 杜
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
| | - 文峰 熊
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China
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Liu H, Li L, Ding Q, Ge Y, Ding Y, Wang S, Fei H. Application of Kirschner wire placement guided technology in paediatric supracondylar humerus fractures. BMC Musculoskelet Disord 2024; 25:56. [PMID: 38216954 PMCID: PMC10787493 DOI: 10.1186/s12891-023-07160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND To analyze the clinical efficacy of K-wire placement guided technology in paediatric supracondylar humerus fractures. METHODS A retrospective study was conducted in 105 patients who underwent closed reduction and percutaneous pinning surgeries in our hospital from June 2019 to August 2022. 54 patients treated with a assisted reduction fixation device to assist in closed reduction and percutaneous K-wire cross-fixation were allocated into the Non-guided group, and 51 patients with K-wire placement guided technology to guide K-wire placement were assigned into the Guided group. The operation duration, number of disposable K-wire placement, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time and Flynn score of elbow joint function at the final follow-up were compared between two groups. The postoperative complications of two groups were recorded. RESULTS There were significant differences between two groups in terms of operation duration, intraoperative fluoroscopy frequency, and disposable K-wire placement rate (p < 0. 05), while no significant differences of Baumann angle, carrying angle and the fracture healing time between two groups were observed (p > 0. 05). In the control group, ulnar nerve injury in 2 case, pin site infection in 4 cases, mild cubitus varus in 2 cases and loss of reduction in 4 cases were detected. In the study group, ulnar nerve injury in 1 case, pin site infection in 2 cases and loss of reduction in 1 case was observed. There was no significant difference in Flynn scores between two groups. CONCLUSION K-wire placement guided technology is simple and convenient. The application of K-wire placement guided technology could relatively improved disposable K-wire placement rate, shorten the intraoperative fluoroscopy frequencies and reduce complication rates.
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Affiliation(s)
- Huan Liu
- Department of Orthopedics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, China
| | - Lingzhi Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qirui Ding
- Department of Orthopedics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, China
| | - Yunru Ge
- Department of Orthopedics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, China
| | - Ying Ding
- Huaiyin Normal University, Huaian, 223300, China
| | - Shouguo Wang
- Department of Orthopedics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, China.
| | - Haodong Fei
- Department of Orthopedics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, China.
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Chen C, Zhang Y, Chen H, Sun J, Yao C. The effects of postoperative malrotation alignment on outcomes of Gartland type III/IV paediatric supracondylar humeral fractures treated by close reduction and percutaneous K-wire fixation. J Orthop Surg Res 2024; 19:26. [PMID: 38167111 PMCID: PMC10763312 DOI: 10.1186/s13018-023-04505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE In this study, we aimed to investigate the effects of postoperative malrotation alignment on the outcomes of Gartland type III/IV paediatric supracondylar humeral fracture (SCHF) treated by close reduction and percutaneous K-wire fixation. METHODS Between January 2014 and December 2021, 295 Gartland type III/IV paediatric SCHFs treated by close reduction and percutaneous K-wire fixation were selected for this retrospective study. The demographic, clinical and radiographic parameters of all cases were collected. The lateral rotation percentage (LRP) was measured on X-rays to evaluate postoperative malrotation alignment of the fracture. All cases were categorized into 4 groups according to LRP: LRP ≤ 10% (210, 71.2%), 10% < LRP ≤ 20% (41, 13.9%), 20% < LRP ≤ 30% (26, 8.8%) and LRP > 30% (18, 6.1%). The carrying angle, ranges of multidirectional motions, Mayo Elbow Performance Score (MEPS) and Flynn's Standard Score (FSS) of the injured elbow were assessed 6 months postoperation and compared among different groups. ROC analysis based on LRP and the excellent/good rate of FSS was performed to determine the acceptable maximum degree of postoperative malrotation alignment. RESULTS There was no difference in the demographic characteristics (age, sex, injured side and fracture type), postoperative Baumann angle, carrying angle or range of forearm rotation among the 4 groups (P > 0.05). The operation time and time from operation to K-wire removal were longer in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). The shaft condylar angle, range of elbow flexion, MEPS and FSS of the injured elbow 6 months postoperatively were lower in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). ROC analysis based on LRP and the excellent/good rate of FSS showed an area under the curve of 0.959 (95% CI 0.936-0.983), with a cutoff value of 26.5%, sensitivity of 95.3% and specificity of 90.1%. CONCLUSION A certain degree of residual malrotation alignment deformity of the SCHF may reduce the shaft condylar angle and extend the time from operation to removing the K-wire and affect elbow function, especially the range of elbow flexion. The acceptable maximum degree of residual malrotation deformity expressed as the LRP value was 26.5%.
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Affiliation(s)
- Cao Chen
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Yafeng Zhang
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Hao Chen
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Jie Sun
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China
| | - Chen Yao
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, 20 Xisi Road, Nantong City, 226001, Jiangsu Province, People's Republic of China.
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Dong Y, Tian L, Li X, Cui Y. Removal of Wires for Sternal Internal Fixation After Cardiac Surgery in Adolescents. Altern Ther Health Med 2024; 30:351-357. [PMID: 37793333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Objective The objective of this study was to assess the safety and patient satisfaction of sternal wire removal surgery, rendering reference for clinical practice in the future. Methods A total of 70 adolescent patients with completely healed sternum and no other diseases or able to receive surgery were randomly selected and subjected to sternal wire removal surgery. Besides, relevant data including patient age, gender, wire rupture, reason for wire removal, postoperative wire residuals, patient satisfaction, age at cardiac surgery, waiting time after cardiac surgery, and removal duration were recorded. Results Raptured wire group exhibited higher proportions of males and chest pain cases and longer operative time than unruptured wire group. The demand for wire removal had no relation to gender, but patients receiving surgery due to chest pain were mainly aged 12-15 years old, those undergoing surgery due to employment and further education were mainly aged 9-12 years old, and those subjected to surgery sue to ruptures found in physical examinations were mainly aged 6-9 years old. According to statistics of wire rupture position, the rupture of the 4th wire accounted for the largest proportion, and rupture of multiple wires was found in some patients. No statistically significant differences were found in gender, age, age at cardiac surgery, and waiting time after cardiac surgery between patients with only one wire ruptured and those with multiple wires ruptured. Patients were grouped based on the absence and presence of chest pain, and it was found that chest pain group had a longer removal duration, but comparable age at cardiac surgery and waiting time after cardiac surgery, and the waiting time after cardiac surgery was a risk factor for chest pain. The waiting time after cardiac surgery was positively correlated with operative time, so we recommend that if there were symptoms of chest discomfort, it should be removed as soon as possible. However, due to the needs of the patients, no control group was set up, which is the limitation of this study. In the next step, we will conduct more long-term observation of the patients to confirm whether the chest pain can be relieved by itself without removing the wire. Conclusion This study found that for adolescent patients with chest pain or other life troubles after cardiac surgery, removing the sternal internal fixation wire can quickly and effectively relieve the troubles, and is a safe and reliable treatment means. Therefore, if it is necessary to remove the wire, it should be removed as soon as possible to avoid wire breakage and increase the difficulty of surgery.
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Bassi C, Heimann AF, Schwab JM, Tannast M, Raabe I. Modified Kapandji technique in pediatric displaced distal radius fractures: results in 195 patients. Eur J Orthop Surg Traumatol 2024; 34:489-497. [PMID: 37632546 PMCID: PMC10771361 DOI: 10.1007/s00590-023-03686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The modified Kapandji technique has been proposed for fracture reduction in pediatric displaced distal radius fractures (DDRFs), but evidence is sparse. The purpose of this study was to evaluate our outcomes and complications, critically and systematically, when performing the modified Kapandji technique in pediatric DDRFs. Using this technique since 2011, we asked: (1) What is the quality of fracture reduction using this technique? (2) How stable is fracture alignment with this technique? (3) What are the postoperative complications and complication rates? METHODS Retrospective observational study of 195 pediatric patients treated with the modified Kapandji technique. Quality of fracture reduction, fixation type (intrafocal, combined, or extrafocal), and coronal/sagittal angulation were recorded at surgery and healing. Perioperative complications were graded. Patients were stratified by fracture (metaphyseal or Salter-Harris) and fixation type, as well as age (≤ 6 years; 6 to 10 years; > 10 years). RESULTS Fracture reduction was 'good' to 'anatomical' in 85% of patients. 'Anatomical' fracture reduction was less frequent in metaphyseal fractures (21% vs. 51%; p < .001). Mean angulation change was higher in metaphyseal fractures in both the sagittal (p = .011) and coronal (p = .021) planes. Metaphyseal fractures showed a higher mean change in sagittal angulation during fracture healing for the 'intrafocal' group. We observed a 15% overall complication rate with 1% being modified Sink Grade 3. CONCLUSION The modified Kapandji technique for pediatric DDRFs is a safe and effective treatment option. Metaphyseal fractures that do not involve the physis should be treated with extrafocal or combined wire fixation. Complications that require additional surgical treatment are rare. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- Cristina Bassi
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland
| | - Alexander F Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland.
| | - Joseph M Schwab
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland
| | - Ines Raabe
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg - Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2 - 6, 1700, Fribourg, Switzerland
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Tekin SB, Karabulut Ç, Bozgeyik B, Bahadir Gökçen H. Treatment of pediatric femur supracondylar fractures: comparison of K-wire fixation versus plate-screw fixation. J Pediatr Orthop B 2024; 33:70-75. [PMID: 37040655 DOI: 10.1097/bpb.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
This study aims to compare the clinical and radiological results of patients who underwent plate-screw fixation and K-wire fixation in supracondylar femur fractures in the pediatric population. Patients aged 5-14 years suffering from supracondylar femoral fractures who underwent K-wire and plate-screw fixation were included in the study. Of all patients, follow-up period, age, fracture union time, gender, leg length discrepancy, and Knee Society Score (KSS) data were analyzed. The patients were divided into two groups; fixation with plate (Group A) and fixation with K-wires (Group B). Forty-two patients participated in the study. There was no significant difference between the two groups in terms of age, gender, and follow-up time ( P > 0.05). When comparing the KSS results, no statistically significant difference was found between the two groups ( P = 0.612). A statistically significant difference was detected between the two groups regarding union time ( P = 0.01). When both groups were analyzed, no significant difference was found between the two groups in terms of functional results. Good results can be obtained in both plate-screw and K-wires in pediatric supracondylar femur fractures.
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Affiliation(s)
| | - Çağri Karabulut
- Department of Orthopedic Surgery, Gaziantep University, Gaziantep
| | - Bahri Bozgeyik
- Department of Orthopedic Surgery, Kadirli State Hospital, Kadirli
| | - H Bahadir Gökçen
- Department of Orthopedic Surgery, Istinye University Liv Hospital Ulus, Istanbul, Turkey
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Özçakar L, Analay P, Öztürk AM, Atalar H. Sciatic nerve entrapment after hip replacement: Ultrasound spotlighting the cerclage wire. PM R 2024; 16:108-109. [PMID: 37162020 DOI: 10.1002/pmrj.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Pelin Analay
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Akif Muhtar Öztürk
- Department of Orthopedic Surgery and Traumatology, Gazi University Medical School, Ankara, Turkey
| | - Hakan Atalar
- Department of Orthopedic Surgery and Traumatology, Gazi University Medical School, Ankara, Turkey
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Yang T, Zhu F, Wang H, Wu B, Jia D, Meng C, Zhao Y. Kirschner Wire Internal Fixation of the Medial Tibiotalar Joint for Indirect Repair of Deltoid Ligament Injury: A Retrospective Comparative Study. Orthop Surg 2024; 16:140-148. [PMID: 38086605 PMCID: PMC10782261 DOI: 10.1111/os.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Ankle joint fractures are often accompanied by medial deltoid ligament rupture. There is controversy over whether or how to treat deltoid ligament rupture. This study was aimed to explore the feasibility of repairing the medial deltoid ligament using Kirschner wire internal fixation of the medial tibiotalar joint combined with external fixation. METHODS Forty-six patients with ankle fractures involving deltoid ligament rupture, treated between October 2012 and February 2021, were retrospectively evaluated. Twenty-five patients were treated with a Kirschner wire to fix the tibiotalar joint and indirectly repair the deltoid ligament as the repaired group. Twenty-one patients underwent reduction and fixation of internal and external malleolus fractures, and the deltoid ligament was not repaired in the unrepaired group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), Medical Outcomes Short Form 36-item questionnaire score (SF-36), and Medial clear space perpendicular (preoperative, postoperative, final follow-up) were used for functional evaluations and reduction assessments. Mann-Whitney test were used to compare the differences between the groups. RESULTS The follow-up time was 13-112 months with a mean of 59.32 months for the repaired group and 11-94 months with a mean of 53.43 months for the unrepaired group. There was no significant difference in the operative time or intraoperative blood loss between the two groups (p > 0.05). At the last follow-up, the AOFAS ankle-hindfoot and SF-36 scores of the repaired group were significantly higher than those of the non-repaired group (p < 0.05). Moreover, the VAS pain score was significantly lower and the Medial clear space perpendicular was significantly narrower in the repaired group than that in the unrepaired group. CONCLUSION Tibiotalar joint fixation using Kirschner wires is a simple and effective technique that can indirectly reduce and repair the deltoid ligament and stabilize the ankle.
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Affiliation(s)
- Tao Yang
- Jining Medical UniversityJiningChina
| | - Fenghua Zhu
- Department of OncologyAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Haibin Wang
- Department of Traumatic OrthopedicsAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Bin Wu
- Department of Traumatic OrthopedicsAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Dailiang Jia
- Department of Emergency SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Chunyang Meng
- Department of Spine SurgeryAffiliated Hospital of Jining Medical UniversityJiningChina
| | - Yifeng Zhao
- Department of Traumatic OrthopedicsAffiliated Hospital of Jining Medical UniversityJiningChina
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Olçar HA, Özer A, Mutu HB, Yurdakul G, Kuru T, Aydın D, Korkmaz M. Computational Mechanical Analysis of AO 44A1, 44B1, and 44C1 Fractures with Finite Element Modeling: Evaluation of Screw, Plate, and Kirschner Wire Fixation. J Am Podiatr Med Assoc 2024; 114:22-155. [PMID: 37647297 DOI: 10.7547/22-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The aim of this study was to create AO 44A1, 44B1, and 44C1 fractures using finite element analysis to determine the stability of Kirschner wire, intramedullary screw, and plate-screw fixation methods in fracture. METHODS Using finite element analysis, the postreduction behavior of AO 44A1, 44B1, and 44C1 fractures with Kirschner wire, intramedullary screw, and plate-screw fixation methods was analyzed and compared in terms of displacement and stress. RESULTS The lowest amount of displacement was provided with the intramedullary screw method in AO 44A1 and 44B1 fractures and with the 4-mm Kirschner wire method in AO 44C1 fractures. The total displacement of the intramedullary screw system used for fixation in AO 44A1, 44B1, and 44C1 fractures was lower. CONCLUSIONS According to finite element analysis results, the lowest amount of displacement was obtained with intramedullary screw fixation in AO 44A1 and 44B1 fractures, and 4-mm Kirschner wire fixation was achieved in AO 44C1 fractures.
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Affiliation(s)
- Hacı Ali Olçar
- *Department of Orthopaedics and Traumatology,Yozgat Bozok University, Yozgat,Turkey
| | - Alaettin Özer
- †Department of Mechanical Engineering, Yozgat Bozok University, Yozgat, Turkey
| | - Halil Burak Mutu
- ‡Department of Mechanical Engineering, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Göker Yurdakul
- §Department of Orthopaedics and Traumatology, Sarikaya State Hospital, Yozgat, Turkey
| | - Tolgahan Kuru
- ‖Department of Orthopaedics and Traumatology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Davut Aydın
- *Department of Orthopaedics and Traumatology,Yozgat Bozok University, Yozgat,Turkey
| | - Murat Korkmaz
- *Department of Orthopaedics and Traumatology,Yozgat Bozok University, Yozgat,Turkey
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Xie WP, Chen XH, Zhou SJ, Chen Q, Cao H. Sternal Pin Used to Close Sternum in Infants after Cardiac Surgery. Thorac Cardiovasc Surg 2024; 72:77-83. [PMID: 37230479 DOI: 10.1055/s-0043-1768967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE A retrospective study was conducted to explore the efficacy of bioabsorbable poly-L-lactic acid sternal pins in sternal closure in infants after cardiac surgery. METHODS A total of 170 infantile patients who underwent cardiac surgery were divided into the steel wire group (group A), the PDS cord group (group B), and the steel wire + sternal pin group (group C). The occurrence of the thoracic deformity was evaluated by vertebral index (VI), frontosagittal index (FSI), and Haller index (HI) values; the stability of the sternum was evaluated by detecting sternal dehiscence and displacement. RESULTS By comparing the absolute values of the differences in VI, FSI, and HI in the three groups, it was found that the difference values of VI and HI in group C were significantly lower than those in group B (p = 0.028 and 0.005). For the highest deformation index, the deformation rate of infants in group C before discharge and during the 1-year follow-up was lower than that in group A and group B (p = 0.009 and 0.002, respectively). The incidence of sternal displacement in group C was also significantly lower than that in groups A and B (p = 0.009 and 0.009). During the 1-year follow-up, there was no sternal dehiscence, and the sternum healed completely in the three groups. CONCLUSION The use of "steel wire + sternal pin" for sternal closure in infants after cardiac surgery can reduce the occurrence of sternal deformity, reduce anterior and posterior displacement of the sternum, and improve sternal stability.
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Affiliation(s)
- Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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马 海, 周 志, 张 思, 刘 方, 华 中, 孙 锡, 贾 国, 孙 军. [Short-term effectiveness of ultrasound-guided Kirschner wire provocation technique in treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1477-1481. [PMID: 38130190 PMCID: PMC10739665 DOI: 10.7507/1002-1892.202309047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/11/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate the short-term effectiveness of ultrasound-guided closed reduction by Kirschner wire provocation technique in the treatment of Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents. Methods Between May 2019 and May 2022, 41 patients with Salter Harris types Ⅰ and Ⅱ distal tibial epiphyseal fractures were admitted, all of whom had periosteal entrapment on preoperative MRI, and 38 cases (92.7%) were confirmed to have periosteal entrapment by intraoperative ultrasound. There were 24 males and 14 females, the age ranged from 6.8 to 15.7 years, with an average of 10.7 years; and there were 20 cases of Salter Harris type Ⅰ and 18 cases of type Ⅱ. The time from injury to operation was 22-76 hours, with an average of 28.4 hours. The preoperative imaging examination showed excellent alignment in 4 cases, good in 20 cases, and poor in 14 cases. The ultrasound guided Kirschner wire provocation technique for closed reduction and percutaneous Kirschner wire internal fixation were performed. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Anteroposterior and lateral X-ray films of the affected ankle joint were taken before operation, at 3 months after operation, and at last follow-up to observe the healing of the fracture, and anteroposterior X-ray films of the whole length of both lower limbs were taken to evaluate the alignment of the force lines of the affected limbs. The range of motion (ROM), visual analogue scale (VAS) score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used to evaluate ankle function. The mechanical lateral distal tibia angle (mLDTA) and the anatomic anterior distal tibia angle (aADTA) were measured. Results The operation time ranged from 17 to 52 minutes, with an average of 22.6 minutes, and the intraoperative fluoroscopy frequency ranged from 3 to 11 times, with an average of 4.2 times. X-ray examination during operation and at 2 days after operation showed that anatomical reduction was achieved. All patients were followed up 10-24 months, with an average of 16.4 months. All fractures healed in 6.1-7.2 weeks, with an average of 6.3 weeks; no fracture displacement occurred, and the patients recovered to their pre-injury level of motion at 6 months after operation. Needle tail irritation occurred in 2 cases at 4 weeks after operation, and they recovered after symptomatic treatment. During the follow-up, there was no serious complication such as incision deep infection, bone nonunion, delayed union, and malunion. At last follow-up, the patients' alignment were all excellent, and the difference was significant when compared with preoperative one ( Z=-7.471, P<0.001). The VAS score, AOFAS ankle-hindfoot score, dorsiflexion-plantar flexion ROM, varus-valgus ROM, mLDTA, and aADTA significantly improved at 3 months after operation and last follow-up when compared with preoperative ones ( P<0.05). Conclusion Ultrasound-guided closed reduction by Kirschner wire provocation technique for treating Salter-Harris types Ⅰ and Ⅱ periosteal entrapment of distal tibial epiphyseal fractures in children and adolescents is minimally invasive and safe.
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Affiliation(s)
- 海龙 马
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 志林 周
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 思成 张
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 方 刘
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 中托 华
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 锡玮 孙
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 国强 贾
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
| | - 军 孙
- 安徽医科大学儿童医学中心 安徽省儿童医院骨科(合肥 230051)Department of Orthopedics, Anhui Medical University Children’s Medical Center, Anhui Provincial Children’s Hospital, Hefei Anhui, 230051, P. R. China
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Ma HL, Sun XW, Liu F, Hua ZT, Sun J, Zhang SC. Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children. Eur J Med Res 2023; 28:585. [PMID: 38082369 PMCID: PMC10714489 DOI: 10.1186/s40001-023-01560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
AIM AND OBJECTIVE To compare the clinical effect of reconstruction of internal and lateral column periosteal hinge-assisted treatment with Kirschner wire and internal fixation with Kirschner wire in the treatment of multidirectional unstable supracondylar fractures of humerus in children. METHODS A retrospective cohort study was conducted to analyze the clinical data of 48 patients (31 male, 17 female; mean age: 6.7 ± 2.4 years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. Twenty-five cases were treated with Kirschner wire reconstruction of the internal and lateral column periosteal hinge assisted by closed reduction and Kirschner wire internal fixation (study group). Twenty-three cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction, fracture healing time, Baumann angle (BA), shaft-condylar angle (SCA), range of motion (ROM), and Flynn score of elbow at the last follow-up were compared between two groups. Complications such as infection and irritation of Kirschner wire tail were observed in two groups 2 months after the operation. RESULTS All patients were followed up for 10-22 months ([13.85 ± 2.89] months). The average operation time of the control group was 82.1 min, which was significantly longer than that of the study group 32.3 min (P < 0.05). The number of intraoperative fluoroscopy (29.4 ± 9.2) in the control group was significantly higher than that in the study group (15.2 ± 6.3) (P < 0.05). The incision rate of the control group was 17% while that of the study group was 0 (P < 0.05). According to Flynn score, the excellent and good rate of the elbow joint in the control group was 86.9% (20/23). The excellent and good rate of the elbow joint in the study group was 92.0% (23/25) (P > 0.05). There was no significant difference in fracture healing time, BA, SCA, and ROM between the two groups (P > 0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up. CONCLUSION Reconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time and reduce intraoperative fluoroscopy times and incision rate.
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Affiliation(s)
- Hai-Long Ma
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Xi-Wei Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Fang Liu
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Zhong Tuo Hua
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Jun Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Si-Cheng Zhang
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China.
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Widanage KND, De Silva MJ, Dulantha Lalitharatne T, Bull AMJ, Gopura RARC. Developments in circular external fixators: A review. Injury 2023; 54:111157. [PMID: 37951162 DOI: 10.1016/j.injury.2023.111157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
Circular external fixators (CEFs) are successfully used in orthopedics owing to their highly favorable stiffness characteristics which promote distraction osteogenesis. Although there are different designs of external fixators, how these features produce optimal biomechanics through structural and component designs is not well known. Therefore, the aim of this study was to conduct a review on CEFs following the PRISMA statement. A search for relevant research articles was performed on Scopus and PubMed databases providing the related keywords. Furthermore, a patent search was conducted on the Google Patent database. 126 records were found to be eligible for the review. Different designs of CEFs were summarized and tabulated based on their specific features. A bibliometric analysis was also performed on the eligible research papers. Based on the findings, the developments of CEFs in terms of materials, automation, adjustment methods, component designs, wire-clamping, and performance evaluation have been extensively discussed. The trends of the CEF design and future directions are also discussed in this review. Significant research gaps include a lack of consideration towards ease of assembly, effective wire-clamping methods, and CEFs embedded with online patient-monitoring systems, among others. An apparent lack of research interest from low-middle and low-income countries was also identified.
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Affiliation(s)
- Kithmi N D Widanage
- Department of Engineering and Design, University of Sussex, Falmer, Brighton, BN1 9RH, United Kingdom; Department of Mechanical Engineering, University of Moratuwa, Moratuwa, 10400, Sri Lanka.
| | | | | | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, SW7 2BX, United Kingdom
| | - R A R C Gopura
- Department of Mechanical Engineering, University of Moratuwa, Moratuwa, 10400, Sri Lanka
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Rechenmacher AJ, Helmkamp J, Brown M, Paul AV, Campbell ST, Pean CA, DeBaun MR. Interfragmentary strain measurement post-fixation to guide intraoperative decision making: a narrative review. Eur J Orthop Surg Traumatol 2023; 33:3299-3305. [PMID: 37284986 DOI: 10.1007/s00590-023-03605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Interfragmentary strain influences whether a fracture will undergo direct and indirect fracture healing. Orthopedic trauma surgeons modulate strain and create optimal biomechanical environments for specific fracture patterns using fixation constructs. However, objective intraoperative interfragmentary strain measurement does not currently inform fixation strategy in common practice. This review identifies potential methods and technologies to enable intraoperative strain measurement for guiding optimal fracture fixation strategies. METHODS PubMed, Scopus, and Web of Science were methodologically queried for manuscripts containing terms related to "bone fracture," "strain," "measurement," and "intraoperative." Manuscripts were systematically screened for relevance and adjudicated by three reviewers. Relevant articles describing methods to measure interfragmentary strain intraoperatively were summarized. RESULTS After removing duplicates, 1404 records were screened initially. There were 49 manuscripts meeting criteria for in-depth review. Of these, four reports were included in this study that described methods applicable to measuring interfragmentary strain intraoperatively. Two of these reports described a method using instrumented staples, one described optical tracking of Kirschner wires, and one described using a digital linear variable displacement transducer with a custom external fixator. CONCLUSION The four reports identified by this review describe potential methods to quantify interfragmentary strain after fixation. However, further studies are needed to confirm the precision and accuracy of these measurements across a range of fractures and fixation methods. Additionally, described methods require the insertion and likely removal of additional implants into the bone. Ideally, innovations that measure interfragmentary strain intraoperatively would provide dynamic biomechanical feedback for the surgeon to proactively modulate construct stability.
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Affiliation(s)
- Albert J Rechenmacher
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA.
| | - Joshua Helmkamp
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Matthew Brown
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Sean T Campbell
- UC Davis Medical Center, Department of Orthopaedic Surgery, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Suite 1700, Sacramento, CA, 95817, USA
| | - Christian A Pean
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
| | - Malcolm R DeBaun
- Department of Orthopaedic Surgery, Duke University Hospital, 200 Trent Drive, Durham, NC, 27710, USA
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McMAHON ME, Ibrahim S. Retro-Antegrade Technique in the Management of Severely Angulated Fourth and Fifth Metacarpal Neck Fractures: A Case Series. J Hand Surg Asian Pac Vol 2023; 28:685-694. [PMID: 38129762 DOI: 10.1142/s2424835523500728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background: This study introduces a novel method for the management of closed metacarpal neck fractures. Kirschner wires (K-wire) are introduced in a retrograde and the wires withdrawn through skin proximally at the base of the metacarpal. The fracture is reduced using traction and the reduction is maintained by antegrade advancement of the K-wires. The aim of this study is to report the outcomes of this technique. Methods: A total of 36 patients with severely angulated closed metacarpal neck fractures underwent reduction and fixation using this novel method from January 2017 to December 2020 in centres in Ireland and Saudi Arabia. We performed a retrospective review of these patients' clinical data examining their outcomes. Results: Six months postoperatively, all fractures demonstrated bony union and correction of angulation. All patients exhibited excellent range of motion (ROM) with no significant impairment of hand function. Conclusions: The method detailed here is a simple, minimally invasive and reliable technique that has not previously been described. It is suitable for use in the management of closed metacarpal neck fractures of the fourth and fifth metacarpal, with dorsal angulation greater than 60°. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Mary Ellen McMAHON
- Plastic & Reconstructive Surgery Department, Beaumont Hospital, Dublin, Ireland
| | - Safwat Ibrahim
- Plastic & Reconstructive Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Kuo HM, Huang HK, Yin CY, Huang YC, Wang JP. Innovative Approach to Unicondylar Proximal Phalangeal Fracture Fixation: Combining Antegrade Intramedullary Pinning With Flexion Proximal Interphalangeal Joint Transfixation. Tech Hand Up Extrem Surg 2023; 27:249-252. [PMID: 37534399 DOI: 10.1097/bth.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Various surgical techniques have been described for the fixation of displaced unicondylar fractures of the proximal phalanx, with K-wire and interfragmentary screws being the most commonly used. Although open reduction with joint exposure can provide direct visualization and allow for anatomic reduction, its potential drawbacks, such as joint stiffness and loss of range of motion, are of significant concern. We introduced a novel fixation technique for displaced unicondylar fractures of the proximal phalanx using antegrade intramedullary pinning and transfixation of the proximal interphalangeal joint, which is simple, effective, and does not require open reduction.
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Affiliation(s)
- Hsueh-Min Kuo
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopedics, National Yang Ming Chiao Tung University, Taipei
| | - Hui-Kuang Huang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopedics, National Yang Ming Chiao Tung University, Taipei
- Department of Orthopedics, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Yu Yin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopedics, National Yang Ming Chiao Tung University, Taipei
| | - Yi-Chao Huang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopedics, National Yang Ming Chiao Tung University, Taipei
| | - Jung-Pan Wang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital
- Department of Orthopedics, National Yang Ming Chiao Tung University, Taipei
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Fredj AB, Rbai H, Chatbouri F, Berriri M, Daadoucha A, Boughattas A. Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases. Int Orthop 2023; 47:2901-2906. [PMID: 36897363 DOI: 10.1007/s00264-023-05765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. METHOD Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. RESULTS According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63-82°) and the mean lateral capitellohumeral angle was 41° (32-50°). CONCLUSION Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement.
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Affiliation(s)
- Aymen Ben Fredj
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia.
| | - Hedi Rbai
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Farouk Chatbouri
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Marouene Berriri
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Abderrahmen Daadoucha
- Radiology Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Anouar Boughattas
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
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Ulus SA, Akar MS. Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures. Eur Rev Med Pharmacol Sci 2023; 27:11764-11770. [PMID: 38164839 DOI: 10.26355/eurrev_202312_34774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. PATIENTS AND METHODS Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. RESULTS For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. CONCLUSIONS Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.
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Affiliation(s)
- S A Ulus
- Department of Orthopedics and Traumatology, Dicle University Medical School, Diyarbakır, Turkey.
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Wu R, Wen Y, Wang C, Liu T, Yu J. Elastic stable intramedullary nailing versus Kirschner wire in the treatment of pediatric metaphyseal-diaphyseal junction fractures of the distal radius: a case-control study. BMC Musculoskelet Disord 2023; 24:922. [PMID: 38037015 PMCID: PMC10688113 DOI: 10.1186/s12891-023-07055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Several methods have been used for the treatment of pediatric distal radius fractures, such as the elastic stable intramedullary nail (ESIN), Kirschner wire (K-wire), and plate, but there has been no consensus about the optimum method. The purpose of this study was to compare ESIN and K-wire techniques used in metaphyseal-diaphyseal junction (MDJ) fractures of the pediatric distal radius. METHODS The data of patients who were treated at a children's hospital affiliated with Shandong University between August 2018 and January 2022 were analyzed retrospectively. The children were divided into the ESIN and K-wire groups. Clinical outcomes were measured by the Gartland and Werley scoring system. Variables were analyzed using a statistical approach between the two groups. RESULTS The study included 26 patients, of whom 11 were treated with K-wire and 15 with ESIN. At the final follow-up, all of the fractures were healed. There were no differences in terms of age, sex, fracture location, or wrist function score. However, the ESIN was superior to K-wire in operative time, fluoroscopic exposure, and estimated blood loss (EBL). CONCLUSIONS K-wire and ESIN are both effective methods in the treatment of MDJ fractures of the pediatric distal radius. The use of the ESIN technique represents less EBL, fluoroscopy exposure, and operation time compared with K-wire. We recommend osteosynthesis by ESIN rather than K-wires in patients with MDJ fractures of the distal radius. LEVEL OF EVIDENCE III, a case-control study.
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Affiliation(s)
- Rongchang Wu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing, 100045, China
| | - Yuwei Wen
- Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing, 100045, China
| | - Chunhua Wang
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China.
| | - Tao Liu
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China
| | - Jiazhi Yu
- Department of Orthopaedics, Children's Hospital Affiliate to Shandong University (Jinan Children's Hospital), No.23976 Jishi Road, Shandong Jinan, 250022, China
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Yokoyama Y, Yamamoto T, Oyama T, Lee J, Machida Y, Endo D, Sato Y, Dohi S, Amano A, Tabata M. Sternal closure with sandwiched three-piece bioresorbable mesh reduces postoperative hemorrhage: a retrospective study. J Cardiothorac Surg 2023; 18:345. [PMID: 38012743 PMCID: PMC10683106 DOI: 10.1186/s13019-023-02460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Median sternotomy is the most performed procedure in cardiac surgery; however, sternal displacement and bleeding remains a problem. This study aimed to investigate whether sternal reconstruction using a sandwiched three-piece bioresorbable mesh plate can prevent postoperative sternal displacement and bleeding more than a bioresorbable pin. METHODS Patients (n = 218) who underwent median sternotomy were classified according to whether a sandwiched three-piece bioresorbable mesh plate and wire cerclage (group M, n = 109) or a bioresorbable pin and wire cerclage (group P, n = 109) were used during sternal reconstruction. The causes of postoperative sternal displacement and bleeding with computed tomography data were analyzed and compared between the groups. RESULTS The preoperative patient characteristics did not significantly differ between the groups. However, the evaluation of sternal and substernal hematoma on postoperative day 5 using computed tomography showed sternal displacement in 4 (4%) and 22 (20%) patients, and substernal hematoma in 17 (16%) and 41 (38%) patients in groups M and P, respectively; this difference was significant. Furthermore, the amount of bleeding at 6 h postoperatively was lower in group M than in group P (235 ± 147 vs. 284 ± 175 mL, p = 0.0275). Chest reopening, intubation time, and length of intensive care unit and hospital stays did not differ between the groups. The evaluation of substernal hematoma based on computed tomography yielded a significantly lower for group M than for group P, revealing that the mesh plate was an independent predictor of substernal hematoma prevention. CONCLUSION Sternal fixation with a three-piece bioresorbable mesh plate could prevent postoperative sternal displacement, bleeding, and substernal hematoma more than sternal fixation with a pin.
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Affiliation(s)
- Yasutaka Yokoyama
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Cardiovascular Surgery, Toda chuo General Hospital, 1-19-3, Honcho, Toda, Saitama, 335-0023, Japan.
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuma Oyama
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Cardiovascular Surgery, Toda chuo General Hospital, 1-19-3, Honcho, Toda, Saitama, 335-0023, Japan
| | - Jiyoung Lee
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Cardiovascular Surgery, Toda chuo General Hospital, 1-19-3, Honcho, Toda, Saitama, 335-0023, Japan
| | - Yoichiro Machida
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Cardiovascular Surgery, Toda chuo General Hospital, 1-19-3, Honcho, Toda, Saitama, 335-0023, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuichiro Sato
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Cardiovascular Surgery, Toda chuo General Hospital, 1-19-3, Honcho, Toda, Saitama, 335-0023, Japan
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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