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Ye K, Cashin M, Van de Velde SK, Khot A, Graham K, Rutz E. Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques. J Child Orthop 2023; 17:607-617. [PMID: 38050598 PMCID: PMC10693844 DOI: 10.1177/18632521231200060] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/22/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose We compared the outcomes of arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in 31 adolescents with cerebral palsy, using three different methods of fixation: K-wires, non-locking plates, and locking plates. Methods Clinical outcomes included time to weight-bearing, fusion rates and surgical complications. Radiographic assessment included comparing pre- and post-operative hallux valgus angles, intermetatarsal angles, interphalangeal angles, and lateral metatarsophalangeal angles. Patient-reported outcomes included pre- and post-operative visual analogue scales addressing bunion pain and concerns, difficulties with wearing shoes and braces, and difficulties with foot hygiene. Results Of the 31 adolescents (16 male), 10 patients had K-wire fixation, 11 had a non-locking dorsal plate, and 10 had fixation with a dorsal locking plate. Mean age at surgery was 16 years (12-18 years) and mean follow-up was 4 years (2.7-6.5 years). Patients with K-wire fixation had delayed weight-bearing and had more complications than those managed by dorsal plating. There were significant improvements in radiographic parameters (except interphalangeal angle) and in patient-reported outcomes, in all groups (p < 0.001). However, radiographic and clinical outcomes were better in the dorsal plating groups compared to the K-wire group. Conclusion Arthrodesis of the first metatarsophalangeal joint gave good correction of deformity with improvements in symptoms and radiographic parameters in adolescents with cerebral palsy. We recommend dorsal plating that allowed early weight-bearing and had fewer complications with better clinical and radiographic outcomes, than K-wire fixation. Level of evidence IV: Retrospective case series.
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Affiliation(s)
- Ken Ye
- Orthopaedic Department, The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - Megan Cashin
- Janeway Children’s Health and Rehabilitation Centre, St. John’s, NL, Canada
| | | | - Abhay Khot
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
| | - Kerr Graham
- The University of Melbourne, Parkville, VIC, Australia
| | - Erich Rutz
- The Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
- Bob Dickens Chair, Paediatric Orthopaedic Surgery, The University of Melbourne, Parkville, VIC, Australia
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Xie W, Li H, Zhang C, Cui X, Zhang S, Rui Y, Chen H. Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture-dislocations. BMC Musculoskelet Disord 2023; 24:880. [PMID: 37951888 PMCID: PMC10638746 DOI: 10.1186/s12891-023-07020-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations. METHODS A total of 67 patients with ankle fracture-dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 10-point visual analog scale (VAS) score (range 0-10), and complications before and after the definitive surgery were recorded. RESULTS A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036). CONCLUSION Ankle fracture-dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.
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Affiliation(s)
- Wenjun Xie
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - He Li
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Cheng Zhang
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Xueliang Cui
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Sheng Zhang
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Yunfeng Rui
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Hui Chen
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
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Bredikhin M, Sawant S, Gross C, Antonio ELS, Borodinov N, Luzinov I, Vertegel A. Highly Adhesive Antimicrobial Coatings for External Fixation Devices. Gels 2023; 9:639. [PMID: 37623093 PMCID: PMC10453896 DOI: 10.3390/gels9080639] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
Pin site infections arise from the use of percutaneous pinning techniques (as seen in skeletal traction, percutaneous fracture pinning, and external fixation for fracture stabilization or complex deformity reconstruction). These sites are niduses for infection because the skin barrier is disrupted, allowing for bacteria to enter a previously privileged area. After external fixation, the rate of pin site infections can reach up to 100%. Following pin site infection, the pin may loosen, causing increased pain (increasing narcotic usage) and decreasing the fixation of the fracture or deformity correction construct. More serious complications include osteomyelitis and deep tissue infections. Due to the morbidity and costs associated with its sequelae, strategies to reduce pin site infections are vital. Current strategies for preventing implant-associated infections include coatings with antibiotics, antimicrobial polymers and peptides, silver, and other antiseptics like chlorhexidine and silver-sulfadiazine. Problems facing the development of antimicrobial coatings on orthopedic implants and, specifically, on pins known as Kirschner wires (or K-wires) include poor adhesion of the drug-eluting layer, which is easily removed by shear forces during the implantation. Development of highly adhesive drug-eluting coatings could therefore lead to improved antimicrobial efficacy of these devices and ultimately reduce the burden of pin site infections. In response to this need, we developed two types of gel coatings: synthetic poly-glycidyl methacrylate-based and natural-chitosan-based. Upon drying, these gel coatings showed strong adhesion to pins and remained undamaged after the application of strong shear forces. We also demonstrated that antibiotics can be incorporated into these gels, and a K-wire with such a coating retained antimicrobial efficacy after drilling into and removal from a bone. Such a coating could be invaluable for K-wires and other orthopedic implants that experience strong shear forces during their implantation.
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Affiliation(s)
- Mikhail Bredikhin
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (M.B.); (S.S.)
| | - Sushant Sawant
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (M.B.); (S.S.)
| | - Christopher Gross
- Department of Orthopedic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Erik L. S. Antonio
- Department of Materials Science and Enfineering, Clemson University, Clemson, SC 29634, USA; (E.L.S.A.); (N.B.); (I.L.)
| | - Nikolay Borodinov
- Department of Materials Science and Enfineering, Clemson University, Clemson, SC 29634, USA; (E.L.S.A.); (N.B.); (I.L.)
| | - Igor Luzinov
- Department of Materials Science and Enfineering, Clemson University, Clemson, SC 29634, USA; (E.L.S.A.); (N.B.); (I.L.)
| | - Alexey Vertegel
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA; (M.B.); (S.S.)
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Abul A, Karam M, Al-Shammari S, Giannoudis P, Pandit H, Nisar S. Peri-operative Antibiotic Prophylaxis in K-Wire Fixation: A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:1000-1007. [PMID: 37384006 PMCID: PMC10293142 DOI: 10.1007/s43465-023-00879-6] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/20/2023] [Indexed: 06/30/2023]
Abstract
Introduction There are currently no standardised guidelines on whether antibiotic prophylaxis is required for Kirschner wire (K-wire) fixation to minimise the risk of surgical site infection when used in patients undergoing clean orthopaedic surgery. Purpose To compare the outcomes of antibiotic prophylaxis versus no antibiotic in K-wire fixation when used in either in trauma or elective orthopaedics. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all randomised controlled trials (RCTs) and non-randomised studies comparing the outcomes of antibiotic prophylaxis group versus those without antibiotic in patients undergoing orthopaedic surgery in which K-wire fixation was used. Incidence of surgical site infection (SSI) was the primary outcome. Random effects modelling was used for the analysis. Results Four retrospective cohort studies and one RCT were identified with a total of 2316 patients. There was no significant difference between the prophylactic antibiotic and no antibiotic groups in terms of incidence of SSI (odds ratio [OR] = 0.72, P = 0.18). Conclusions There is no significant difference in administering peri-operative antibiotics for patients undergoing orthopaedic surgery using K-wire.
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Affiliation(s)
- Ahmad Abul
- Division of Surgical and Interventional Sciences, University College London, Gower Street, London, WC1E 6BT UK
| | - Mohammad Karam
- Department of Surgery, Farwaniya Hospital, Kuwait City, Kuwait
| | | | - Peter Giannoudis
- Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK
| | - Hermant Pandit
- Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK
| | - Sohail Nisar
- Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK
- Leeds Institute of Rheumatic and Muskuloskeletal Medicine, Chapel Allerton, Leeds, UK
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Shams A, Samy MA, Mesregah MK, Abosalem AA. Scapho-luno-capitate fusion with proximal lunate articular surface preservation for management of grade IIIA Kienböck's disease: a prospective case series. J Orthop Traumatol 2023; 24:23. [PMID: 37199858 DOI: 10.1186/s10195-023-00703-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Kienböck's disease is idiopathic lunate avascular necrosis, which may lead to lunate collapse, abnormal carpal motion and wrist arthritis. The current study aimed to assess the outcomes of treating stage IIIA Kienböck's disease by a novel technique of limited carpal fusion via partial lunate excision with preservation of the proximal lunate surface and scapho-luno-capitate (SLC) fusion. MATERIALS AND METHODS We conducted a prospective study of patients with grade IIIA Kienböck's disease managed with a novel technique of limited carpal fusion comprising SLC fusion with preservation of the proximal lunate articular cartilage. Autologous iliac crest bone grafting and K-wires fixation were used to enhance the osteosynthesis of the SLC fusion. The minimum follow-up period was 1 year. A visual analog scale (VAS) and the Mayo Wrist Score were utilized for the evaluation of patient residual pain and functional assessment, respectively. A digital Smedley dynamometer was used to measure the grip strength. The modified carpal height ratio (MCHR) was used for monitoring carpal collapse. The radioscaphoid angle, scapholunate angle, and the modified carpal-ulnar distance ratio were used for the assessment of carpal bones alignment and ulnar translocation of carpal bones. RESULTS This study included 20 patients with a mean age of 27.9 ± 5.5 years. At the last follow-up, the mean range of flexion/extension range of motion (% of normal side) improved from 52.8 ± 5.4% to 65.7 ± 11.1%, P = 0.002, the mean grip strength (% of normal side) improved from 54.6 ± 11.8% to 88.3 ± 12.4%, P = 0.001, the mean Mayo Wrist Score improved from 41.5 ± 8.2 to 81 ± 9.2, P = 0.002, and the mean VAS score reduced from 6.1 ± 1.6 to 0.6 ± 0.4, P = 0.004. The mean follow-up MCHR improved from 1.46 ± 0.11 to 1.59 ± 0.34, P = 0.112. The mean radioscaphoid angle improved from 63 ± 10º to 49 ± 6º, P = 0.011. The mean scapholunate angle increased from 32 ± 6º to 47 ± 8º, P = 0.004. The mean modified carpal-ulnar distance ratio was preserved and none of the patients developed ulnar translocation of the carpal bones. Radiological union was achieved in all patients. CONCLUSIONS Scapho-luno-capitate fusion with partial lunate excision and preservation of the proximal lunate surface is a valuable option for treating stage IIIA Kienböck's disease, with satisfactory outcomes. Level of evidence Level IV. Trial registration Not applicable.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Ahmed Samy
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| | - Ahmed Abdelazim Abosalem
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
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Fortis AP, Dedes V, Vergados N, Panoutsopoulos GI. Modified tension band wiring technique by safely inserting K-wires in olecranon fracture osteosynthesis. Folia Med (Plovdiv) 2023; 65:221-225. [PMID: 37144306 DOI: 10.3897/folmed.65.e78264] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/24/2022] [Indexed: 05/06/2023] Open
Abstract
AIM The present study presents the results of a modified tension band technique by surgically inserting K-wires to treat olecranon fractures. MATERIALS AND METHODS The modification includes inserting the K-wires from the olecranon's upper tip and directing them to the ulna's dorsal surface. Twelve patients (three males and nine females) from 35 to 87 years of age were operated for olecranon fracture. After the standard approach, the olecranon was reduced and fixed with two K-wires from the tip to the dorsal ulnar cortex. Then the standard tension band technique was carried out. RESULTS The average operating time was 17.25±3.08 min. No image intensifier was used since the wires' discharge was either visible, penetrating the dorsal cortex, or palpable through this area's skin. The time needed for the bone union was six weeks. In one female patient, the wires were cut out. This patient showed a satisfactory painless range of motion (ROM) of the elbow but did not achieve full ROM. However, this particular patient had a previous removal of the radial head, and she spent some time in the ICU intubated. The modified technique used here is as stable as the classic operation, and it is safe since there is no risk of injuring the nerves and vessels of the olecranon fossa. There is less or no need for an image intensifier. CONCLUSION The outcomes of the present study are entirely satisfactory. However, many patients and randomized studies are needed to establish this modified tension band wiring technique.
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Alayed Y, Alrashedan BS, Almisfer SK, Aldossari AM. Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study. J Brachial Plex Peripher Nerve Inj 2023; 18:e27-e31. [PMID: 37404323 PMCID: PMC10317565 DOI: 10.1055/s-0043-1771012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Background Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. Hypothesis Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. Patients and Methods This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. Result The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration ( p < 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, p < 0.038) as well as ORIF (odds ratio = 26.2, p < 0.001). Conclusion Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. Level of Evidence Prognostic III.
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Affiliation(s)
- Yazeed Alayed
- Department of Pediatrics, Children Hospital, King Saud Medical City, Ulaishah, Riyadh, Saudi Arabia
| | - Bander S. Alrashedan
- Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, Riyadh, Saudi Arabia
| | - Sultan K. Almisfer
- Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, Riyadh, Saudi Arabia
| | - Ali M. Aldossari
- Division of Paediatric Orthopaedic Surgery, Department of Orthopedic Surgery, King Saud Medical City, Ulaishah, Riyadh, Saudi Arabia
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Abstract
BACKGROUND Intramedullary nail (IMN) fixation of metacarpal fractures is an alternative to Kirschner wire (K-wire) fixation. The goal of this study was to compare the biomechanical properties of K-wire fixation with a threaded IMN (InNate; ExsoMed, Aliso Viejo, California). METHODS The study design was based on previously described biomechanical models for evaluating metacarpal fractures. Sixteen fresh frozen small finger-matched and ring finger-matched pairs were randomized to either IMN or 0.045 in K-wire fixation after receiving a standardized neck osteotomy. Proper implant placement was confirmed with plain radiographs. Specimens then underwent loading in a 3-point bend configuration. Load to failure (LTF), stiffness, and fracture displacement were recorded. Mechanical failure was defined by a sharp change in the load-displacement curve. RESULTS Age, sex, sidedness (left or right), and digit (ring or small finger) were evenly distributed between groups. The IMN had a significantly higher LTF than K-wires (546 N vs 154 N, P < .001). The K-wire fixation demonstrated plastic deformation between 75 and 150 N. Intramedullary nail stiffness was higher than that of K-wires (155.89 N/mm vs 59.28 N/mm, P < .001). CONCLUSIONS When surgical fixation is indicated for metacarpal neck and shaft fractures, the threaded IMN is biomechanically superior to crossed K-wires with the application of 3-point bend.
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Affiliation(s)
- Midhat Patel
- The University of Arizona College of
Medicine – Phoenix, USA
| | - Paulo Castañeda
- The University of Arizona College of
Medicine – Phoenix, USA
| | | | - Jill G. Putnam
- The University of Arizona College of
Medicine – Phoenix, USA
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Caravelli S, Gardini G, Pungetti C, Gentile P, Perisano C, Greco T, Rinaldi VG, Marcheggiani Muccioli GM, Tigani D, Mosca M. Intra-Articular Calcaneal Fractures: Comparison between Mini-Invasive Approach and Kirschner Wires vs. Extensive Approach and Dedicated Plate-A Retrospective Evaluation at Long-Term Follow-Up. J Clin Med 2022; 12:jcm12010020. [PMID: 36614821 PMCID: PMC9821005 DOI: 10.3390/jcm12010020] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Calcaneal fractures (CF) are the most common tarsal fractures, representing up to 75% of foot fractures and 2% of all fractures. The aim of this retrospective study is to analyze fixation with Kirschner wires through a mini-invasive approach and dedicated plate and screws through an extended approach at long-term follow-up. MATERIALS AND METHODS Patients were radiographically and clinically evaluated at final follow-up, by using the validated American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score for the clinical-functional assessment, the Short-Form 12 (SF-12) for the physical and psychological domain assessment, and the Visual Analog Scale (VAS) for pain. RESULTS In total, 38 patients (42 CF) met the inclusion criteria and were retrospectively evaluated and divided into two groups (Kirschner group and plate group) consisting of 19 patients each. The overall mean follow-up was 59.4 ± 11.8 months. The average values of the post-operative clinical outcomes of the two groups KG and PG were, respectively, 70.7 ± 11.9 and 70.1 ± 10.9 (AOFAS), 45.7 ± 6.8 and 46.5 ± 10.8 (SF-12 PCS), 54.7 ± 9.9 and 50.9 ± 11.8 (SF-12 MCS) at the final follow-up. CONCLUSIONS The present study showed that in the cases analyzed, the two surgical approaches used for the treatment of CF achieved comparable clinical outcomes. The only substantial difference found between the two groups of patients was the re-intervention rate that afflicted them.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Giammarco Gardini
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Camilla Pungetti
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Paolo Gentile
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Carlo Perisano
- Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Tommaso Greco
- Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Vito Gaetano Rinaldi
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Domenico Tigani
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Tamiti L, Braymand S, Bahlouli N, Facca S, Sapa MC, Liverneaux P. K-wire pullout strength in hand surgery: Impact of diameter, threading length and drilling speed. Orthop Traumatol Surg Res 2022; 108:103248. [PMID: 35181514 DOI: 10.1016/j.otsr.2022.103248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of the present study was to assess the impact, combined and in interaction, of diameter, threading length and drilling speed on K-wire pullout strength in a synthetic model of a hand bone. MATERIAL AND METHODS The material comprised Sawbones® (20 ×20×50mm), K-wires (diameter 1.2mm, 1.5mm, 1.8mm; threading 0mm, 5mm, 10mm, 15mm), a universal chuck with T handle and a drill (speed 0, 320, 500, 830, 1,290rpm), and tensile testing machine and a digital decision aid. The Sawbones® were drilled, varying diameter, threading and speed. The Statistical Design of Experiments (SDOE) methodology enabled the number of trials to be reduced from 300 to 70. Tensile tests at 1mm/s was imposed on the K-wire up to pullout (pullout strength). RESULTS There was no interaction between threading length and diameter effects or between drilling speed and diameter effects, but a strong interaction between drilling speed and threading length effects. CONCLUSION Before using K-wires for internal fixation in wrist or hand fracture, the surgeon has to select their characteristics, optimal holding power being theoretically ensured by large diameter wires with long threading inserted by a high-speed drill. LEVEL OF EVIDENCE I, experimental study.
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Affiliation(s)
- Louisa Tamiti
- ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France
| | - Sandrine Braymand
- ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France
| | - Nadia Bahlouli
- ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France
| | - Sybille Facca
- ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France; Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France
| | - Marie Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France
| | - Philippe Liverneaux
- ICube CNRS UMR7357, Strasbourg University, 2-4, rue Boussingault, 67000 Strasbourg, France; Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1, avenue Molière, 67200 Strasbourg, France.
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11
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Biz C, Cerchiaro M, Belluzzi E, Bortolato E, Rossin A, Berizzi A, Ruggieri P. Treatment of Distal Radius Fractures with Bridging External Fixator with Optional Percutaneous K-Wires: What Are the Right Indications for Patient Age, Gender, Dominant Limb and Injury Pattern? J Pers Med 2022; 12:jpm12091532. [PMID: 36143316 PMCID: PMC9503670 DOI: 10.3390/jpm12091532] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this retrospective study was to evaluate the medium-term clinical and functional outcomes of patients with closed, displaced, and unstable, simple or complex, intra- and extra-articular distal radius fractures (DRFs) treated with a bridging external fixator (BEF) and optional K-wires (KWs). AO classification was used to differentiate the injuries radiographically. Clinical-functional outcomes were evaluated using the Patient-Rated Wrist and Hand Evaluation Score (PRWHE Score) and the Quick Disabilities of the Arm Shoulder and Hand Score (QuickDASH). A total of 269 dorsally displaced fractures of 202 female (75%) and 67 male subjects (25%) were included, with a mean follow-up of 58.0 months. Seventy-five patients (28%) were treated by additional KWs. No differences were found comparing the two groups of patients (BEF vs. BEF + KWs) regarding age, sex, and fracture side (dominant vs. non-dominant). PRWHE and QuickDASH scores were lower in the BEF + KWs group compared to the BEF group (p < 0.0001 and p = 0.0007, respectively). Thus, patients treated with KWs had a better clinical outcome. Beta multivariate regression analysis confirmed that patients of the BEF + KWs group exhibited a better PRWHE score but not a better QuickDASH score. Patients treated by the BEF + KWs with the fracture on the dominant site were characterised by better clinical outcomes. Older patients had a better PRWHE score independently from the treatment. Our findings suggest that the use of BEF for DRFs with optional KWs can be indicated in both young and elderly patients of any gender, independent of limb side and fracture pattern. As the best functional results were achieved in the elderly when KWs were added, the combination of BEF and KWs seems to be mainly indicated for the treatment of DRF, also complex, in the elderly population.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-3348
| | - Elena Bortolato
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Antonio Berizzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
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Gupta J, Harkin EA, O'Connor K, Enobun B, O'Hara NN, O'Toole RV. Surgical factors associated with symptomatic implant removal after patella fracture. Injury 2022; 53:2241-2246. [PMID: 35341597 DOI: 10.1016/j.injury.2022.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/03/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether certain types of fixation and other factors associated with the fixation could be identified that predict an increased risk of symptomatic implant removal. METHODS We conducted a retrospective cohort study at our urban academic level 1 trauma center. Patients aged ≥18 years who underwent operative fixation for patella fracture were included. The primary outcome was symptomatic implant removal after operative fixation. RESULTS Of the 186 study patients (mean age, 44 [SD 17] years, 65% male), 53 patients (28.5%) underwent symptomatic implant removal. Modifiable risk factors for symptomatic implant removal included the use of Kirschner (k)-wires (OR: 4.93; 95% CI, 1.89-14.10; p < 0.001), and a trend towards significance for implant prominence >5 mm (OR: 2.57; 95% CI, 0.93-7.93; p = 0.07). Symptomatic implant removal was also less likely in patients >45 years of age (OR: 0.14; 95% CI, 0.06-0.34; p < 0.01), of a racial minority (OR: 0.40; 95% CI, 0.17-0.88; p = 0.03), and a body mass index >25 kg/m2 (OR: 0.39; 95% CI, 0.18-0.84; p = 0.02). The final model demonstrated excellent prognostic performance, with an AUC of 0.83 (0.76-0.90). CONCLUSION We identified both modifiable and non-modifiable factors associated with symptomatic implant removal in patients with patella fractures. Surgeons should be aware that the use of k-wires and any implant prominence exceeding 5 mm might be associated with increased odds of symptomatic implant removal in patients with patella fractures.
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Affiliation(s)
- Jayesh Gupta
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elizabeth A Harkin
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine O'Connor
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Blessing Enobun
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O'Toole
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
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Herold J, Kamin K, Bota O, Dragu A, Rammelt S. Complete avulsion of the heel pad with talar and calcaneal fracture: salvage with multiple K-wire anchorage, internal fixation and free ALT flap. Arch Orthop Trauma Surg 2022; 143:2429-2435. [PMID: 35467124 PMCID: PMC10110715 DOI: 10.1007/s00402-022-04439-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/30/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few cases have been reported with different treatment regimens. METHODS Here, we report on a 46-year-old female patient with complex foot trauma consisting of complete avulsion of the heel pad at the hindfoot and a soft tissue defect at the posterior aspect of the heel accompanied by rupture of the anterior tibial tendon and fractures of the talus, calcaneus and midfoot. The sole of the foot was fixed to the calcaneus with multiple temporary Kirschner wires and moist wound dressings. The anterior tibial tendon was sutured. The soft tissue defect at the posterior heel was treated with a free anterolateral thigh flap. The fractures were fixed in staged procedures. RESULTS At 2-year follow-up, the patient had a durable soft tissue cover over the heel with full sensation over the sole and a pliable flap over the posterior aspect of the heel. The patient was able to fully bear weight and was pain free during her daily activities in comfortable, custom shoes. All fractures had healed, the talar neck fracture after one revision and bone grafting. The foot was plantigrade and stable with preserved painless but limited range of motion at the ankle, subtalar and mid-tarsal joints. CONCLUSION The unique tissue at the sole of the foot can be salvaged even in cases of full degloving at the hindfoot with the simple method of anchorage with multiple temporary K-wires. Traumatic defects of the vulnerable skin at the posterior aspect of the heel requires durable coverage with free flap coverage. With staged treatment of all bone and soft tissue injuries, a favorable result can be obtained even in case of a complex foot trauma.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - O Bota
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - A Dragu
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - S Rammelt
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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14
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Holding J, Devsam BU. Down to the wire: Patient and family experiences of k-wire removal in a paediatric specialist clinic. Int J Orthop Trauma Nurs 2021;:100903. [PMID: 34756830 DOI: 10.1016/j.ijotn.2021.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/12/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION K-wire removal is a common procedure in the paediatric outpatient clinic that is a source of pain and anxiety. This study examined the current parental experience of k wire removal. METHODS Twenty-six parents of children having k-wires removed in a paediatric outpatient clinic were asked to complete an electronic survey immediately post procedure. Questions explored prior knowledge, sedation and analgesia for the procedure. Data analysis used descriptive statistics. RESULTS Verbal information from the ward prior to the procedure was the greatest information source for parents 22/26(85%). Thirty-eight % (10/26) of parents had expected sedation but only 6/10(23%) reported receiving sedation information. Only 7/26(27%) of parents reported their child receiving analgesia from themselves or medical staff pre-procedure. DISCUSSION Parents recommended the need for more procedural information beforehand, especially regarding pain and sedation. Parents were unaware of the option of sedation and wanted analgesia before the procedure.
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15
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Al-Omari AA, Alrawashdeh M, Obeidat O, Al-Rusan M, Essa SB, Radaideh AM, Altamimi AA. Entrapped long head of biceps tendon in pediatric proximal humerus fracture dislocation: A case report and review of the literature. Ann Med Surg (Lond) 2021; 67:102510. [PMID: 34257957 DOI: 10.1016/j.amsu.2021.102510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl. Case presentation A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast. Clinical discussion Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles. Conclusions A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation. Combined proximal humerus fracture & glenohumeral dislocation in the pediatric population is extremely rare occurrences •High index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation •Open reduction with K-wires fixation for irreducible combined proximal humeral fracture & glenohumeral dislocation is the best treatment option.
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16
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Li J, Tang SP, Mei HB, Shao JF, Shi BJ, Wang HQ, Tang X. Comparison of two methods in the treatment of congenital pseudarthrosis of clavicle: multicenter experience. J Orthop Surg Res 2021; 16:301. [PMID: 33964943 PMCID: PMC8106166 DOI: 10.1186/s13018-021-02438-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Congenital pseudoarthrosis of the clavicle (CPC) is an uncommon entity. Owing to its scarce presentation, treatment of this disorder has not been well established. This study aimed (1) to compare surgical treatment methods that included excision of pseudoarthrosis and iliac crest bone graft and fixate with either the elastic stable intramedullary nail (ESIN) or K-wires or plate and screws, and (2) to assess the clinical outcomes of two different surgical methods. Methods A multi-central retrospective study was performed between 2013 and 2017 in four tertiary teaching hospitals. Fifteen clavicles of 11 children were identified as CPC. All patients underwent pseudarthrosis resection and iliac crest bone autograft. They were divided into two groups as per the surgical treatment they underwent—plate stabilization as group A and elastic stable intramedullary nailing (ESIN) or K-wires as group B. Nine clavicles in 6 patients in group A and 6 clavicles in 5 patients in group B, were included. The Quick Disabilities of the Arm and Shoulder (QuickDASH) score was used to assess patients’ satisfaction and function following treatment at each follow-up. Results There were eight boys and three girls, with an average age of 4.7 years. All patients, except one with intellectual impairments, had radiological healing. Implant removal time was significantly shorter in group B compared to group A. No statistically significant differences existed in terms of age at surgery, time of radiological healing, complication, and clinical outcome between different groups. Conclusion Surgical resection of pseudoarthrosis with an iliac crest bone graft was an effective means of surgical treatment in CPC. However, ESIN or K-wires can achieve shorter union time compared to the plate. Hence, surgical treatment is recommended for congenital pseudarthrosis of clavicular in pediatric patients. Level of evidence Retrospective comparative study; Level III
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Affiliation(s)
- Jin Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sheng Ping Tang
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen, 518046, China
| | - Hai Bo Mei
- Department of Orthopedics, Hunan Children's Hospital, Changsha, 410007, China
| | - Jing Fan Shao
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bao Jie Shi
- Department of General Surgery, Xiang'an Hospital of Xiamen University, Xiamen, 361000, China
| | - Hai Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xi'an, 712046, Xixian District, China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Wichlas F, Hofmann V, Strada G, Moursy M, Deininger C. Off-label use of orthopedical trauma implants in a low-income country. Int Orthop 2021. [PMID: 33638004 DOI: 10.1007/s00264-021-04990-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Abstract
Purpose Lack of resources, severe injuries, and logistical flaws force surgeons in low-income countries (LIC) to improvise during surgery and use implants “off-label.” These off-label treatments are specific for the work of trauma surgeons in non-governmental (NGO) hospitals in LIC. The aim of this study is to show the need of off-label surgery in an environment of low resources by means of typical examples. Methods Off-label treated fractures, the implant used instead, and the reason for off-label treatment were investigated in 367 injuries over a three month period in an NGO hospital in Sierra Leone. Results Twenty-seven fractures were treated off-label with mostly K-wires (88.89%) and external fixators (51.85%). Three reasons for off-label use could be defined: no suitable implants (N = 14), the condition of soft tissues that did not allow internal osteosyntheses (N = 10), and implants not ready for surgery due to logistic flaws (N = 3). The implants needed were mostly locking plates. Conclusion Surgeons in similar settings must use K-wires and external fixators to treat complex fractures. Using implants off-label can help surgeons to treat fractures otherwise left untreated.
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Maradei-Pereira JAR, Dos Santos AP, Martins JR, Maradei-Pereira MR. Infection after buried or exposed K-wire fixation of distal radial fractures: a randomized clinical trial. J Hand Surg Eur Vol 2021; 46:154-158. [PMID: 32611274 DOI: 10.1177/1753193420936543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We treated 220 extra-articular distal radial fractures with closed reduction and percutaneous K-wire fixation and randomized K-wire placement to buried or exposed. We analysed the incidence and severity of infection and the mobility of the metacarpophalangeal joints. At 6 weeks postoperatively, 12 patients in the exposed group had infections versus two in the buried group, which was a statistically significant difference. Mobility was statistically but not clinically better in the buried group. One patient in each group had wires removed before fracture healing due to infection, which resulted in malunion. From this study we conclude that, in the treatment of distal radial fractures, it is better to bury the K-wires under the skin, especially when geographical conditions make it difficult to control the patients' adherence to hygiene and postoperative care despite the higher costs incurred with removal of buried K-wires.Level of evidence: II.
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Affiliation(s)
- João Alberto R Maradei-Pereira
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brazil.,Hospital Maradei, Clínica dos Acidentados, Belém, PA, Brazil
| | | | - Juliana R Martins
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brazil
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Olson JJ, Dyer GS. Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series. JSES Rev Rep Tech 2021; 1:34-40. [PMID: 37588629 PMCID: PMC10426594 DOI: 10.1016/j.xrrt.2020.11.007] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Introduction Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplasty. We describe a novel surgical technique that confers stable fixation, allowing for early range of motion resulting in a high rate of union, a functional range of motion, and excellent patient reported outcome scores without the activity restrictions of total elbow arthroplasty. Methods Retrospective case series of 30 patients with AO/OTA type B and C intra-articular distal humerus fractures who underwent ORIF from 2014-2019 utilizing a novel surgical technique that focuses on reconstructing a comminuted articular surface through meticulous, transverse fixation of the tiny articular fragments with long, thin Kirchner wires, which are then bent over and trapped under locking compression plates to create a fixed angle support to the metadiaphysis. Results Patient mean age of 59 (19-90) years and 61% were female. Median follow up was 1.2 years. Twenty-seven (87%) were type C fractures and 3 (13%) were type B. Five patients (16%) suffered a concurrent ipsilateral upper extremity injury and four (13%) had an open fracture. Two were polytrauma patients. All fractures healed with an average time to union of 11 weeks. Over 80% patients reported no or mild pain at final follow up. Mean arc of elbow motion was 102 degrees, mean QuickDASH score 25.2. Post-operative complications included ulnar nerve paresthesias (38%), wound infection (3.2%), heterotopic ossification (3.2%), and olecranon nonunion (3.2%). Eight patients underwent secondary procedures: 7 (23%) removal hardware, 3(9.6%) capsular release, 2 (6.4%) ulnar nerve transpositions, and 1 (3.2%) total elbow arthroplasty. Conclusion We describe a novel surgical technique that we believe results in strong, stable fixation of complex intra-articular distal humerus fractures irrespective of bone quality. In our series, all fractures healed and post-operatively patients reported low levels of pain, achieved excellent elbow range of motion, high patient reported outcome scores. Patients should be counseled about high rates of post-operative ulnar nerve paresthesias that can be expected to improve over time and high reoperation rates for symptomatic hardware.
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Affiliation(s)
- Jeffrey J. Olson
- Harvard Combined Orthopaedic Surgery Program, Boston, MA, USA
- Orthopaedic Trauma Initiative at Harvard Medical School, Boston, MA, USA
| | - George S.M. Dyer
- Harvard Combined Orthopaedic Surgery Program, Boston, MA, USA
- Orthopaedic Trauma Initiative at Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
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Morsi IM, Khalifa AA, Hussien MA, Abdellatef A, Refae H. Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF). Foot (Edinb) 2020; 45:101740. [PMID: 33011495 DOI: 10.1016/j.foot.2020.101740] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/06/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Optimum management of displaced intra-articular calcaneal fractures (DIACF) still controversial. Open surgery carries the risk of wound complications, while non-operative management has a high incidence of arthrosis. To avoid these complications, minimally invasive and percutaneous fixation was introduced. The purpose of this study was to prospectively evaluate the short term clinical and radiological outcomes after closed reduction and percutaneous fixation of DIACF using K-wires. PATIENTS AND METHODS Outcomes of twenty patients were evaluated at the final follow up. A functional assessment using the AOFAS scoring system. Radiological parameters recorded included three angles (Böhler's, Gissane and posterior facet inclination angles) and three distances (calcaneal length, height and width). Any complications were reported at any follow-up. RESULTS The mean patient's age was 33 ± 15.2 years, 8 (40%) patients with type II fractures, 10 (50%) patients with type III fractures, and 2 (10%) with type IV fracture according to Sanders classification. After a mean follow-up of 9 months, the mean AOFAS score was 84, excellent in 9 patients (45%), good in 9 (45%), and fair in 2 (10%). At the final follow-up the Böhler's angle, Gissane angle and PFIA was 25.1° ± (5.2), 119.9° ± (9.4) and 51.7° ± (5.9) respectively and the calcaneal height, length and width was 41.8 mm ± (2.1), 75.1 mm ± (3.01) and 40.9 mm ± (2.6) respectively. We had no cases of deep infection, 20% had significant subtalar arthritis. CONCLUSION The closed reduction and percutaneous fixation technique for DIACF management offered acceptable clinical and radiographic outcomes, with fewer complications when compared to other management options.
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Affiliation(s)
- Ibrahim Mahmoud Morsi
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | | | - Ahmed Abdellatef
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Hesham Refae
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
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van Delft EA, Vermeulen J, Schep NW, van Stralen KJ, van der Bij GJ. Prevention of secondary displacement and reoperation of distal metaphyseal forearm fractures in children. J Clin Orthop Trauma 2020; 11:S817-S822. [PMID: 32999562 PMCID: PMC7503138 DOI: 10.1016/j.jcot.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Metaphyseal distal forearm fractures are common in paediatric patients and treating these fractures by reduction and cast immobilization alone is under debate, since secondary displacement is a frequent complication that often warrants re-intervention. This study was conducted to invest the incidence of secondary displacement and re-intervention for non-displaced and displaced fractures, with or without fixation. MATERIAL AND METHODS A retrospective cohort study was conducted analysing all consecutive paediatric patients under the age of 16 with distal metaphyseal forearm fractures throughout a 2-year period. Data were recorded on radiographic characteristics, OTC/AO-classification, type of treatment, reduction technique, surgical interventions and removal of hardware and complications. RESULTS 200 Patients with displaced metaphyseal forearm fractures were included of which 139 were primarily treated in the emergency room, the other 61 patients were primarily treated in the operating room. 83% Of the patients had a satisfactory reduction in the emergency room and 94% of these patients were treated successfully with casting alone. A total of 84 patients were treated in the operating room of whom 30% underwent reduction and K-wire fixation, and 70% underwent reduction and casting only. 47% Of the patients treated with closed reduction without K-wire fixation in the operating room suffered from secondary displacement, of which 80% needed re-intervention. CONCLUSION Metaphyseal forearm fractures can be treated with a very high success rate by closed reduction and casting alone in the emergency room. Reduction and casting of displaced metaphyseal forearm fractures in children that needed treatment in the operating room however, resulted in unacceptable high rate of secondary displacement and commonly required re-intervention. Those patients should therefore be treated by reduction and K-wire fixation.
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Affiliation(s)
- Eva A.K. van Delft
- Amsterdam UMC, Vrije Universiteit Amsterdam Department of Trauma Surgery, Amsterdam Movement Sciences, Spaarne Gasthuis, Department of Trauma Surgery Boelelaan 1117, Amsterdam, The Netherlands Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands,Corresponding author.
| | - Jefrey Vermeulen
- Trauma Surgeon, Maasstad Hospital, Department of Trauma Surgery, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands
| | - Niels W.L. Schep
- Trauma Surgeon, Maasstad Hospital, Department of Trauma Surgery, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands
| | - Karlijn J. van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands
| | - Gerben J. van der Bij
- Trauma Surgeon, Spaarne Gasthuis, Department of Trauma Surgery, Boerhaavelaan 22, 2035RC, Haarlem, the Netherlands
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Melamed E, Joo L, Lin E, Perretta D, Capo JT. Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis. J Hand Surg Asian Pac Vol 2019; 22:29-34. [PMID: 28205483 DOI: 10.1142/s0218810417500058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whether percutaneous pinning or plate fixation is more appropriate for metacarpal fractures is still open to debate. Our study purpose was to review the current literature in an attempt to determine the optimal treatment modality for metacarpal fractures on the basis of functional outcomes, radiographic outcome and rates of complications. METHODS We selected Pubmed, Cochrane library, EMBASE and the relevant English orthopedic journals and pooled data from eligible trials including four comparative studies and one retrospective review. Overall, the studies contained 222 patients with 231 fractures, 143 treated with pinning and 88 treated with plates and screws. Mean follow up was 7.5 months (4-12 months). Data were analyzed and the fixed effects are assumed for meta-analysis. RESULTS Patients undergoing pinning for metacarpal fractures have higher motion scores when compared to open reduction and internal fixation with plate and screws. Functional scores, grip strength, radiographic parameters, time to union and complications were found not to be significantly different between the two groups. CONCLUSIONS There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.
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Affiliation(s)
- Eitan Melamed
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - LiJin Joo
- † Department of Biostatistics, Environmental Health Science Program, New York University, New York, NY, USA
| | - Edward Lin
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Donato Perretta
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - John T Capo
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
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23
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Herscovici D Jr, Scaduto JM. Acute management of high-energy lisfranc injuries: A simple approach. Injury 2018; 49:420-4. [PMID: 29157841 DOI: 10.1016/j.injury.2017.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/31/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aims of this study were to (1) describe the use of the K-wire for the initial management of high-energy Lisfranc dislocations or fracture dislocations, (2) to evaluate whether this standalone technique allowed for adequate reduction of these injuries, (3) to evaluate whether reductions were maintained until definitive fixation was performed, (4) and to determine if it contributed to any increase in complications prior to or after definitive fixation. PATIENTS AND METHODS A retrospective review was performed on all patients who presented with tarsometatarsal injuries from January 2005 through June 2015. Dislocations of the tarso-metatarsal joints were classified as either Type A (total incongruity, homolateral complex), Type B (partial incongruity, homolateral incomplete) or Type C (divergent, total or partial displacement) patterns, with or without associated fractures. For the purposes of this paper, high-energy injuries were defined as patients presenting with either a Type A or Type C (total displacement) dislocations or fracture-dislocation patterns. A total of 176 patients presented with a tarsometatarsal injury. Eighteen patients with divergent or homolateral patterns underwent a staged approach. Fifteen patients were managed exclusively with K-wire fixation. Wound complications, infections or the unexpected need to return to surgery were recorded. RESULTS All patients demonstrated an improved alignment using K-wires. There were no compartment syndromes, vascular insufficiency, complications to the skin associated with traction or manipulation, or pin site infections. At definitive fixation, no patient demonstrated a loss in the alignment that had been obtained at the index procedure or had an unexpected return to surgery. DISCUSSION AND CONCLUSIONS This study demonstrates that high-energy Lisfranc injuries are uncommon and that K-wires are a simple and adequate technique that can be used for initial staged approach of these injuries. The use of 2.0mm K-wires were sufficient to obtain and maintain the reduction until definitive fixation has been obtained, without producing any increase risk for complications.
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Abstract
BACKGROUND Comparision of results and complications of exposed versus buried Kirschner wires (K-wires) after open reduction of lateral condyle fractures is scarce and mainly from western population; hence, we envisaged to study the safety and efficacy of exposed and buried K-wires used for fixation of displaced pediatric fracture of the lateral condyle of humerus in Indian setup. MATERIALS AND METHODS A prospective, nonrandomized, comparative study was conducted in 50 patients with age <12 years, presenting with displaced fracture of lateral condyle of humerus of <2 weeks duration, without associated ipsilateral upper limb injury, who were treated by open reduction and internal fixation with either exposed or buried K-wires (n = 25 in each group). At a minimum followup of 3 months, status of fracture reduction, union, evidence of osteomyelitis, carrying angle at the elbow, and elbow range of motion (ROM) were assessed clinicoradiologically. RESULTS Four (16%) patients in exposed group and 1 (4%) in buried group had superficial infection, while 3 (12%) patients in exposed group and 2 (8%) in buried group had deep infection. All the patients with infection responded well to oral antibiotics and regular dressings. Buried group had higher incidence of secondary skin and wire-related complications. CONCLUSION There was no statistical difference between the two groups but exposed K wires are easy to remove so are preferred over buried K wires.
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Affiliation(s)
- Avijeet Prasad
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India,Address for correspondence: Dr. Avijeet Prasad, 726, D-Pocket, Dilshad Garden, New Delhi - 110 095, India. E-mail:
| | - Puneet Mishra
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | | | - Manish Chadha
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | - Rohit Pandey
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
| | - Rahul Anshuman
- Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India
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25
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Mangwani J, Gulati A, Benson R, Cichero M, Williamson DM. Role of prophylactic antibiotics in lesser toe fusion surgery: A prospective randomised controlled trial. Foot Ankle Surg 2017; 23:50-52. [PMID: 28159043 DOI: 10.1016/j.fas.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/10/2016] [Accepted: 02/04/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This prospective randomised controlled trial was performed to determine whether the incidence of local infection is reduced in patients who are administered prophylactic antibiotics for lesser toe fusion surgery. METHODS 100 adult patients undergoing toe fusion surgery that required K-wires to be left in situ for 4-6 weeks were randomly allocated into those who received prophylactic antibiotics (Group 1, n=48) and those who did not (Group 2, n=52). Patients were followed up regularly and during each visit K-wire insertion sites were assessed for signs of pin tract infection. RESULTS The mean age of Group 1 was 58.0 (SD 17.5) and Group 2 was 62.7 years (SD 14.7). The overall infection rate was 4%. Three patients (6.2%) in Group 1 and one patient (1.9%) in Group 2 developed signs of infection, which required treatment by oral antibiotics. All infections were low grade. There were no features suggestive of osteomyelitis in any of the patients. CONCLUSION The overall infection rate in lesser toe fusion surgery is low and that using prophylactic antibiotics does not reduce the incidence. Inappropriate use of antibiotics, however, may contribute to the development of antibiotic resistance and adds to healthcare costs.
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Affiliation(s)
- J Mangwani
- Consultant in Trauma and Orthopaedics, University Hospitals of Leicester, NHS Trust, UK.
| | - A Gulati
- Specialist Registrar in Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, UK.
| | - R Benson
- Consultant in Trauma and Orthopaedic Surgery, Maidstone and Tunbridge Wells NHS Trust, UK
| | - M Cichero
- Consultant Podiatrist-Podiatric Surgeon, Great Western Hospital, Swindon and Marlborough NHS Trust, UK
| | - D M Williamson
- Consultant in Trauma and Orthopaedics, Great Western Hospital, Swindon and Marlborough NHS Trust, UK
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26
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Hernekamp JF, Reinecke A, Neubrech F, Bickert B, Kneser U, Kremer T. Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate. Arch Orthop Trauma Surg 2016; 136:571-8. [PMID: 26914332 DOI: 10.1007/s00402-016-2416-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation. METHODS 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis. RESULTS No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications. CONCLUSION Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.
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Affiliation(s)
- J F Hernekamp
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany
| | - A Reinecke
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany
| | - F Neubrech
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany
| | - B Bickert
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany
| | - T Kremer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann Str. 13, 67061, Ludwigshafen, Germany.
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Hiatt SV, Begonia MT, Thiagarajan G, Hutchison RL. Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures. J Hand Surg Am 2015; 40:1586-90. [PMID: 25980734 DOI: 10.1016/j.jhsa.2015.03.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires. METHODS Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct. RESULTS All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size. CONCLUSIONS The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires. CLINICAL RELEVANCE When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability in the plane of finger flexion-extension.
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Affiliation(s)
- Stephen V Hiatt
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, MO
| | - Mark T Begonia
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, Kansas City, MO
| | - Ganesh Thiagarajan
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, Kansas City, MO
| | - Richard L Hutchison
- Section of Hand Surgery, Division of Orthopaedic Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO.
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Mahmoud M, Shafie SE, Menorca RMG, Elfar JC. Management of neglected Bennett fracture in manual laborers by tension fixation. J Hand Surg Am 2014; 39:1728-33. [PMID: 25106765 PMCID: PMC4154309 DOI: 10.1016/j.jhsa.2014.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 06/15/2014] [Accepted: 06/17/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the results of open reduction and internal fixation (ORIF) of Bennett fractures in young, active patients using a K-wire and wire loop construct to achieve anatomical reduction and to allow return to manual labor. METHODS In this prospective series, we treated 10 male manual laborers (mean age, 30 y; range, 20-44 y) with Bennett fractures diagnosed after a minimum of 12 weeks (mean, 16 wk; range, 12-18 wk). ORIF using 2 K-wires with a wire loop and a neutralizing transarticular K-wire was performed with direct articular visualization. Patients were evaluated for range of motion, grip strength, and pinch strength, and a visual analog scale score rated pain before surgery and 12 months later. RESULTS The mean follow-up was 16 months (range, 12-36 mo). The average visual analog scale improved from 6 to 2, mean palmar abduction improved from 15° to 40°, mean radial abduction increased from 22° to 39°, average pinch strength improved from 9.9 kg to 15.5 kg, and average grip strength increased from 34 kg to 49 kg. Complications included transient irritation of the radial sensory nerve or lateral cutaneous nerve of the forearm in 3 patients, pin track granuloma formation in 2 patients, and marginal osteophyte formation in 2 patients. Union was achieved in all 10 patients, and 9 patients returned to their previous manual labor occupation. CONCLUSIONS Our results suggest that neglected Bennett fractures can be effectively managed by ORIF using K-wires and a wire loop without compromising strength or motion. This technique reliably restored the anatomy and provided adequate thumb motion and strength to allow a return to manual labor. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Mostafa Mahmoud
- Kasr El Aini Hospital, Cairo University Medical School, Cairo Egypt
| | - Sherif El Shafie
- Kasr El Aini Hospital, Cairo University School of Medicine, Cairo, Egypt
| | - Ron M. G. Menorca
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation
| | - John C. Elfar
- University of Rochester Medical Center, Department of Orthopedics and Rehabilitation
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29
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Zemirline A, Vaiss L, Lebailly F, Gouzou S, Liverneaux PA, Facca S. The MetaHUS(®) fixation system versus pinning and plating in 5th metacarpal neck fractures. ACTA ACUST UNITED AC 2014; 33:207-10. [PMID: 24857636 DOI: 10.1016/j.main.2014.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/29/2014] [Accepted: 04/07/2014] [Indexed: 11/20/2022]
Abstract
The treatment of fifth metacarpal neck fractures is controversial. The aim of this work was to modify the intermetacarpal pinning technique with an external connector, and to compare the results of this modified technique to those of intramedullary pinning and locking plate techniques. Our series included 56 extra-articular fractures of the neck of the fifth metacarpal treated by intramedullary pinning (group A), locking plate Aptus(®) MEDARTIS™ (group B) and MetaHUS(®) Arex™ (group C); the last one consisted in intermetacarpal percutaneous pinning and connecting the pins externally. There were no statistically significant differences for all criteria except active mobility, which was less important for group B. In groups A and B, 6 complications were noted, in group C, one. Our results showed that blocked intermetacarpal K-wires is a technique of choice for the treatment of displaced fifth metacarpal neck fractures, not only because it is easy to assemble and to remove, but also because it allows immediate active mobilization.
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Kaur S, Harjai K, Chhibber S. Local delivery of linezolid from poly-D,L-lactide (PDLLA)-linezolid-coated orthopaedic implants to prevent MRSA mediated post-arthroplasty infections. Diagn Microbiol Infect Dis 2014; 79:387-92. [PMID: 24809862 DOI: 10.1016/j.diagmicrobio.2014.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
The present study focuses on the use of linezolid as local delivery agent for direct administration of the drug at the orthopaedic implant site. Local drug delivery system with linezolid added to the Poly D, L-(Lactide) polymer solution was used to coat the orthopaedic grade K-wires. Bacterial adherence on K-wires was then determined to evaluate the effect of the coated drug on the adherence of MRSA. A significant decrease in bacterial adherence as compared to naked wires was observed on all the coated K-wires (2.5, 5 and 10% w/w linezolid coated) with maximum decrease of 60%. This represents an aggressive early approach to prevent initial adherence of bacterial population. With the rise in MRSA mediated orthopaedic device related infections, the use of linezolid loaded polymer coated implants is definitely an attractive strategy against drug resistant strains of S. aureus.
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Affiliation(s)
- Sandeep Kaur
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Sanjay Chhibber
- Department of Microbiology, Panjab University, Chandigarh 160014, India.
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Horst K, Dienstknecht T, Pishnamaz M, Sellei RM, Kobbe P, Pape HC. Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation. Patient Saf Surg 2013; 7:18. [PMID: 23721404 PMCID: PMC3681720 DOI: 10.1186/1754-9493-7-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/22/2013] [Indexed: 12/17/2022] Open
Abstract
Background Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation. Material and Methods A retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded. Results 41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group. Conclusion Usage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.
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Affiliation(s)
- Klemens Horst
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Thomas Dienstknecht
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Miguel Pishnamaz
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Richard Martin Sellei
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
| | - Hans-Christoph Pape
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany
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