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ObjectiveThis study used finite element analysis to simulate four commonly used fixation methods for metacarpal shaft oblique fractures during finger motion and evaluate their biomechanical performance. The aim was to provide evidence for clinically selecting the optimal fixation method, guiding early rehabilitation treatment, and reducing the risk of complications.MethodsFinite element analysis simulated dynamic proximal phalanx motion (60° flexion, 20° extension, 20° adduction, and 20° abduction). We analysed stress, displacement, and distributions for dorsal plates, intramedullary nails, Kirschner wire, and screw fixation methods.ResultsAt 60° of finger flexion and 20° of abduction, plate fixation demonstrated greater stability and minimal displacement, with a peak displacement of 0.19 mm; however, it showed higher stress levels in all motion states, increasing the risk of failure. The stability of the intramedullary nail was similar to that of the dorsal plate, with a maximum displacement difference of 0.04 mm, and it performed better than the dorsal plate during adduction of 20°. Kirschner wire showed the highest stress levels of 81.6 Mpa during finger flexion of 60°, indicating a greater risk of failure and unstable displacement. Screws had lower stress levels in all finger motion states, reducing the risk of failure, but had poorer stability. Stress and displacement distributions showed that the dorsal plate, intramedullary nail, and Kirschner wire mainly bore stress on the implants, concentrating near the fracture line and the proximal metacarpal. In contrast, the screws partially bore stress in the screw group. The anterior end of the metacarpal mainly hosted the maximum displacement.ConclusionThis study demonstrates that under simulated finger motion states, the dorsal plate fixation method provides the best stability in most cases, especially during finger flexion and abduction. However, high stress levels also indicate a higher risk of failure. The intramedullary nail is similar to the dorsal plate in stability and performs better in certain motion states. Kirschner wire exhibits the highest risk of failure during flexion. Although screws have poorer stability in some motion states, they offer a lower risk of failure. These findings provide important reference and surgical selection strategies for treating metacarpal fractures.

Background: There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. Methods: This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). Results: During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. Conclusions: The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons. [ABSTRACT FROM AUTHOR]

Yan Ding,1,* Banqin Wang,2,* Yongjun Liu,1 Shengjie Dong,1 Xuri Sun,1 Zhilin Cao,1 Leisheng Wang1 1Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China; 2Department of Blood Transfusion, Shandong Provincial Qianfoshan Hospital Affiliated with Shandong First Medical University, Jinan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Leisheng Wang, Department of Orthopedics, Yantaishan Hospital, No. 10087 Keji Road, Yantai, 264003, People’s Republic of China, Tel +86-13792566016 ; +86-0535-6863898, Email 37724148@qq.comPurpose: Percutaneous pedicle screw fixation is a common minimally invasive treatment for traumatic thoracolumbar and lumbar fractures; however, research on hardware removal after successful healing is limited. We aimed to introduce a rapid, safe, minimally invasive, and cost-effective method for percutaneous pedicle screw removal.Patients and Methods: We conducted a retrospective analysis of demographic (age, sex, body mass index, alcohol use, and current smoking), clinical (hypertension and diabetes mellitus), surgical (affected levels, number of screws, time of surgery, and blood loss), and treatment cost characteristics of 92 patients who had undergone percutaneous pedicle screw removal between May 2016 and February 2023. The first 57 patients underwent the conventional method, and the remaining 35 underwent the modified method. Independent-sample t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, between the two groups.Results: No significant differences were observed in the demographic parameters, complications, or affected levels between the groups. However, the average surgical time (P=0.000) was significantly shorter, and the average blood loss volume (P=0.002) and total cost (P=0.000) were significantly lower in the modified group than in the conventional group.Conclusion: Compared with the conventional method, our modified method can shorten the surgical time, reduce blood loss, and reduce the total cost of treatment. It is a quick and safe minimally invasive method that does not require additional surgical instruments and is suitable for implementation in primary hospitals.Keywords: bone screw, device, Kirschner wire, surgery, control

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 0.5). 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.

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

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.

Abstract Objective The purpose of this study was to compare the therapeutic effects of Kirschner wire fixation and external fixation in the treatment of proximal humeral fractures in older children and adolescents. Methods A retrospective analysis was performed on the clinical data of older children and adolescents who underwent surgery at our institution for proximal humeral fractures between April 2014 and May 2022. One group (n = 28) underwent fracture reduction and Kirschner wire fixation, and the other group (n = 23) underwent external fixation. During the follow-up, the differences in shoulder joint function between the two groups were compared by analysing Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) and Constant-Murley scores. Postoperative complications were also recorded. Results The operation time of the Kirschner wire group was shorter than that of the external fixation group (69.07 ± 11.34 min vs. 77.39 ± 15.74 min, P = 0.33). The time to remove the fixator in the external fixation group was shorter than that in the Kirschner wire group (6.74 ± 1.57 vs. 7.61 ± 1.22, P = 0.032). The Quick DASH score and Constant-Murley score of the patients in the external fixation group were significantly better than those in the Kirschner wire group at 3 months after surgery (5.63 ± 4.33 vs. 8.93 ± 6.40, P = 0.040; 93.78 ± 2.43 vs. 91.75 ± 2.15, P = 0.003). There was no significant difference in the Quick DASH score or Constant-Murley score between the patients in the external fixator group and those in the Kirschner wire group at 9 months after the operation (2.77 ± 3.14 vs. 3.17 ± 3.68, P = 0.683; 97.39 ± 1.80 vs. 96.57 ± 2.15, P = 0.152). The most common complication of the two groups was pin tract infection. The incidence rate of infection was higher in the external fixation group than that in the Kirschner wire group (9 vs. 4, P = 0.043). Conclusion Both Kirschner wire fixation and external fixation of N-H III and IV proximal humeral fractures in older children and adolescents produce good outcomes. External fixation is a preferred surgical treatment option for paediatric proximal humerus fractures because early mobilization of the affected limb can be realized.

Objective The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different immobilization methods' impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and K‐wire to determine which is the most stable and has the fewest complications. Methods Sixty rats aged 5–6 months were selected to establish Achilles tendon injury in two hind legs model. After suturing the ends of the AT together with a modified “Kessler” method (Prolene 5–0). The skin incision was interrupted and sutured with 1–0 thread. Rats were divided into three immobilization methods (plaster cast group, splint group, and K‐wire group). In plaster cast group, the hind leg was cast with plaster in the extended position of the hip and knee joints, and the ankle joint was at 150°. Splint and K‐wire group used splints and 0.8‐mm K‐wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chi‐square test. Results Within 4 weeks observation, K‐wires showed better stability (90%) compared with the other two ways (40% in plaster cast group, 65% in splint group; p

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the therapeutic effects of Kirschner wire fixation and external fixation in the treatment of proximal humeral fractures in older children and adolescents. Methods: A retrospective analysis was performed on the clinical data of older children and adolescents who underwent surgery at our institution for proximal humeral fractures between April 2014 and May 2022. One group (n = 28) underwent fracture reduction and Kirschner wire fixation, and the other group (n = 23) underwent external fixation. During the follow-up, the differences in shoulder joint function between the two groups were compared by analysing Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) and Constant-Murley scores. Postoperative complications were also recorded. Results: The operation time of the Kirschner wire group was shorter than that of the external fixation group (69.07 ± 11.34 min vs. 77.39 ± 15.74 min, P = 0.33). The time to remove the fixator in the external fixation group was shorter than that in the Kirschner wire group (6.74 ± 1.57 vs. 7.61 ± 1.22, P = 0.032). The Quick DASH score and Constant-Murley score of the patients in the external fixation group were significantly better than those in the Kirschner wire group at 3 months after surgery (5.63 ± 4.33 vs. 8.93 ± 6.40, P = 0.040; 93.78 ± 2.43 vs. 91.75 ± 2.15, P = 0.003). There was no significant difference in the Quick DASH score or Constant-Murley score between the patients in the external fixator group and those in the Kirschner wire group at 9 months after the operation (2.77 ± 3.14 vs. 3.17 ± 3.68, P = 0.683; 97.39 ± 1.80 vs. 96.57 ± 2.15, P = 0.152). The most common complication of the two groups was pin tract infection. The incidence rate of infection was higher in the external fixation group than that in the Kirschner wire group (9 vs. 4, P = 0.043). Conclusion: Both Kirschner wire fixation and external fixation of N-H III and IV proximal humeral fractures in older children and adolescents produce good outcomes. External fixation is a preferred surgical treatment option for paediatric proximal humerus fractures because early mobilization of the affected limb can be realized. [ABSTRACT FROM AUTHOR]

BACKGROUND: Distal radial fracture involving dorsal ulnar fragment type belongs to unstable fractures, AO classification of 23C type and the middle column fractures of three-column classification. If dorsal ulnar fragment cannot be effectively fixed, it will affect the stability of radial joints and ulnar radial joints. The fixation effect of dorsal volar plate alone on dorsal ulnar fragment is limited. Although the fixation effect of dorsal volar double plate is effective, it increases the trauma and treatment cost, which is not in line with the current Diagnosis Related Groups policy. The addition of dorsal Kirschner wire fixation may be a relatively feasible plan. OBJECTIVE: A finite element model of AO/ASIF 23-C1 distal radial fracture was established to compare the differences in biomechanical stability between volar locking plate and volar locking plate plus dorsal Kirschner wire, especially focusing on the fixation effect of dorsal ulnar fragment, providing a reference for clinical application. METHODS: Using reverse modeling technology, the CT data of healthy femur of a 42-year-old male and internal fixation data were imported into relevant software to establish three-dimensional finite element models of AO/ASIF 23-C1 distal radial fractures with volar locking plate and volar locking plate with dorsal Kirschner wire. The models were subjected to 100 N axial stress, or 1 Nm bending or torsional stress, respectively. The maximum displacement, maximum Von Mises stress and stress distribution of dorsal ulnar fragment were compared between the two groups. RESULTS AND CONCLUSION: (1) The stress on the internal fixation was 2-10 times that on the bone under the two fixation methods, which met the requirements of fracture fixation. (2) Under the three different loads, there was no significant difference between the two groups in the stress peaks of both bone and internal fixation (< 30%). Under an axial load, the peak stress on the internal fixation was 3-4 times that on the bone. However, under bending load, the peak stress of internal fixation was 8-10 times that of bone, while under torsion load, the peak stress of internal fixation was only twice that of bone. (3) Under an axial load, the maximum displacements of the dorsal ulnar fragment between the two groups were very small and the difference was small, only 0.056 mm and 0.047 mm, respectively, indicating good stability of the fragment. Under bending load, the maximum displacement of single plate group was 2.4 times that of Kirschner wire group. Under torsion load, the maximum displacement of the single plate group was 2.7 times that of the Kirschner wire group. (4) It is indicated that the volar locking plate with Kirschner wire can more effectively fix the dorsal ulnar fracture fragment, with more uniform stress distribution, improve the fixation strength, and does not significantly increase the treatment cost. It is more suitable for the treatment of distal radial fractures involving the dorsal ulnar fracture fragment under the current Diagnosis Related Groups policy. [ABSTRACT FROM AUTHOR]

Objective: The Achilles tendon (AT) is the most frequently ruptured in the human body. Literature describing different immobilization methods' impact on tendon healing after AT repair is lacking. We compare plaster cast, splint, and K‐wire to determine which is the most stable and has the fewest complications. Methods: Sixty rats aged 5–6 months were selected to establish Achilles tendon injury in two hind legs model. After suturing the ends of the AT together with a modified "Kessler" method (Prolene 5–0). The skin incision was interrupted and sutured with 1–0 thread. Rats were divided into three immobilization methods (plaster cast group, splint group, and K‐wire group). In plaster cast group, the hind leg was cast with plaster in the extended position of the hip and knee joints, and the ankle joint was at 150°. Splint and K‐wire group used splints and 0.8‐mm K‐wires, separately. The fixed period was 4 weeks. The incidence of stability and complications (death, necrosis of the legs, necrosis of the skin, and incisional infection) were recorded. Differences were detected using the chi‐square test. Results: Within 4 weeks observation, K‐wires showed better stability (90%) compared with the other two ways (40% in plaster cast group, 65% in splint group; p < 0.05). Rats immobilized with K‐wires (10%) suffered significantly lower complications compared with plaster cast and splint group (15%; p < 0.05). Conclusion: K‐wire has better stability, lower complication rate than other methods. Immobilization with K‐wire may be a promising tool in future clinical Achilles tendon rupture applications. [ABSTRACT FROM AUTHOR]

ObjectiveElastic stable intramedullary nail (ESIN) is a commonly used method for treating diaphyseal fractures of the tibia, but its application in Distal Tibial Diaphyseal Metaphyseal Junction (DTDMJ) fractures has been a subject of controversy. This study aims to evaluate the clinical efficacy of the Elastic stable intramedullary nail-Kirschner wire (E-K) technique in treating pediatric DTDMJ fractures, providing better clinical decision-making for clinicians in diagnosing and treating such fractures.MethodsWe conducted a retrospective analysis of patients aged 3–9 years who received treatment at our hospital from January 2019–January 2021 for distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. Based on their surgical procedures, they were categorized into the Elastic Stable Intramedullary Nail—Kirschner wire group (E-K) and the ESIN group. Demographic data, surgical duration, clinical outcomes, complications, and imaging data were recorded.ResultsThe study included a total of 57 patients, with 24 cases in the E-K group and 33 cases in the ESIN group. There were 30 males and 27 females. The average age was (6.25 ± 1.59) years in the E-K group and (6.27 ± 1.48) years in the ESIN group. There were no significant differences between the two groups in terms of gender, age, weight, time from injury to surgery, follow-up time, side of injury, associated injuries, nail site infection, deep infection, and nail removal time (P > 0.05). Neither group experienced nonunion or refracture. The E-K group exhibited significantly lower coronal and sagittal plane angular values at the final follow-up compared to the ESIN group (P

ObjectiveTo compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation.MethodsFrom January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi ‘an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6 months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups.ResultsAll 43 patients were followed up for an average of 9.7 (9–12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3 days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group.ConclusionThe clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Introduction: We present a large intraosseous ganglion related to hardware migration after ligament reconstruction and tendon interposition (LRTI). Case details: A 51-year-old female underwent LRTI after four years of conservative management for basal joint arthritis. The Kirschner wire (“K-wire”) migrated and was freely mobile for approximately 18 days. The K-wire likely traumatized the first metacarpal, interossei, and radial nerve. Diagnostic imaging revealed a ganglion that occupied approximately 80% of the volume of the first metacarpal. Wary of additional complications, the patient deferred excisional curettage and bone grafting. At 30 months post-operatively, there was persistent pressure and pain within the first metacarpal bone and slight improvement of carpometacarpal arthritis symptoms. Conclusion: To the best of our knowledge, this is the first report of a large intraosseous ganglion associated with hardware migration after LRTI. In a patient who is a reliable historian and has no secondary gain issues, the development of new or worsening symptoms warrants a thorough evaluation. Careful review of clinical and radiographic evidence may identify a specific cause and help to guide management. Even if patients decline to have further surgery, they may appreciate having a diagnosis—intraosseous ganglion—and not being dismissed as “failed hand surgery syndrome.”

Abstract Aim of the work This study was designed to highlight internal fixation by intramedullary K-wires for displaced distal forearm fractures among children and analyze the results of this technique. We hypothesize that physis-sparing intramedullary fixation prevents displacement with a lower complication rate. Methods This prospective case series involving 47 patients was conducted between February 2018 and December 2019. All patients with open physis presented with recent displaced distal forearm fractures were included, and all of them were treated with an intramedullary k-wire fixation for both bones with the assessment of the union rate, union time, suspected complication, radiographic evaluation, and functional outcome. Results The study population consisted of 31 boys (66%) and 16 girls (34%). The mean age of the patients was 10.68 ± 2.728 years (range, 7–15 years). All fractures were united in a median of 6 weeks (range, 4–8 weeks), The functional outcome after 12 months was normal in 42 patients (89.4%), whereas, in five patients (10.6%), the functional parameters were minimally reduced. The median preoperative angulation improved from 36° (range, 24°–52°) preoperatively to 4° (range, 0°–10°) on immediate postoperative radiographs. After 12 months, the median angulation was 2° (range, 0°–7°) (p

Introduction Fixation of the acromioclavicular joint with Kirschner wires (K-wire) has been widely used by orthopeadic and trauma surgeons in the recent past. Now the technique is less common. Migration of Kirschner wires is a common complication being limited to the fixation area in the majority of cases and can be a devastating event in rare cases. The objective was to explore K-wire migration into the spinal canal after acromioclavicular joint repair. Material and methods A clinical case of a broken K-wire migrated into the spinal canal is reported. An unsystematized literature analysis on the topic was performed. Results and discussion A routine examination revealed a K-wire fragment migrated into the spinal canal at the cervical level 7 years after acromioclavicular joint fixation in a 36-year-old man. The pin fragments were removed from the spinal canal and from the acromioclavicular joint site. The postoperative period was uneventful. A good clinical result was obtained, the wounds healed by primary intention. Migration of K-wires into the spinal canal is a rare but severe complication that can lead to injury to the dura mater, the spinal cord and the vertebral artery. There are cases of wire migration reported outside the insertion site: into the lung, mediastinum, esophagus, spleen, intestines, aorta, and heart with the timing of wire migration ranging from 11 days to 12 years of surgery. Conclusion The case report and literature review have shown a risk of K-wire migration into the spinal canal when used for fractures and dislocations. The technique requires dynamic observation of the patient throughout the treatment period. The pins should be removed after fracture healing or dislocation repair. The manipulations can minimize the risk of a fracture and migration of the K-wire s.

Background: Fractures of the metacarpals are often seen in the orthopedic emergency department. Complicated metacarpal fractures are more common than any other type of fracture. The general goal of treating all fractures is for the patient to achieve normal motion. However, the ideal stabilization technique is still debated. For internal fixation, Kirchner wires [Wires] or can be used, each offering several advantages. No previous study has compared the use of Kwire with miniplates in the treatment of unstable metacarpal fractures. Therefore, we conducted this prospective intervention study to evaluate the outcomes of using Kwire and miniplates in the treatment of unstable metacarpal fractures.Aim of the work: To contrast the functional and radiological outcomes of MPIF and also KWIF for the treatment of unstable metacarpal fractures; and to determine which fixation method [Kirschner wire or mini plates] provides the best functional and radiological outcome in the treatment of metacarpal fractures.Patients and Methods: This prospective interventional investigation was performed at the Al-Azhar university Hospital in Damietta, in the department of orthopedic surgery. This study was conducted on 40 patients with unstable metacarpal fractures.Results: There were statistically significant variations among the two groups regarding operative time [minutes], blood loss [milliliters] & hospital stay [day]. The hand grip, DASH, and TAF scores did not differ significantly among the two groups. There was no statistically significant variation in result among the two groups. In regards to complications, there was not a significant distinction among both groups examined.Conclusion: In the treatment of unstable metacarpal fractures, both the Kirschner wire and the Mini Plate proved to be reliable options. Kirschner Wire was related with much less operating time, shorter hospital stay, reduced blood loss, and quicker union time, despite the fact that both procedures had comparable functional outcomes and complication rates.

High-energy trauma has increased significantly in the last decade, mostly in the lower limbs, in many cases requiring fasciotomy due to the subsequent compartment syndrome. In this context, its closure often leads to a delay in the patient’s comprehensive treatment and the return to their activities and may lead to local infection, in addition to generating high costs. There are many options for the plastic surgeon to try to bring the edges together and reconstruct the extremities, such as flaps, grafts, vacuum dressings, and elastic sutures, in addition to expansion devices, sometimes with a combination of the above.

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Aim of the work: This study was designed to highlight internal fixation by intramedullary K-wires for displaced distal forearm fractures among children and analyze the results of this technique. We hypothesize that physis-sparing intramedullary fixation prevents displacement with a lower complication rate. Methods: This prospective case series involving 47 patients was conducted between February 2018 and December 2019. All patients with open physis presented with recent displaced distal forearm fractures were included, and all of them were treated with an intramedullary k-wire fixation for both bones with the assessment of the union rate, union time, suspected complication, radiographic evaluation, and functional outcome. Results: The study population consisted of 31 boys (66%) and 16 girls (34%). The mean age of the patients was 10.68 ± 2.728 years (range, 7–15 years). All fractures were united in a median of 6 weeks (range, 4–8 weeks), The functional outcome after 12 months was normal in 42 patients (89.4%), whereas, in five patients (10.6%), the functional parameters were minimally reduced. The median preoperative angulation improved from 36° (range, 24°–52°) preoperatively to 4° (range, 0°–10°) on immediate postoperative radiographs. After 12 months, the median angulation was 2° (range, 0°–7°) (p < 0.001). The angulation of the distal radius immediately after surgery and at the final follow-up was statistically correlated with the functional outcome (p < 0.001 and 0.002, respectively). Conclusion: This technique provides a good result with less susceptibility to re-displacement and low complication rates. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to assess the application value of distal femur 90° locking plate fixation for supracondylar femoral fractures (SFF) in children. PATIENTS AND METHODS: A total of 100 SFF children with or without diabetes who were enrolled in our hospital from January 2018 to January 2020 were randomized into a control group and a study group by the random number table method. The study group received distal femur locking plate fixation, and the control group adopted Kirschner wire (K wire) internal fixation. The primary outcomes of the two groups of children and the secondary outcomes of the diabetic patients were compared. RESULTS: The fracture union rate of the study group was significantly higher than that of the control group at 12 weeks, 16 weeks, 20 weeks and 24 weeks after the operation (p<0.05), while the rate showed no significant difference between the two groups at 28 weeks after the operation (p>0.05). The two groups showed similar operation time, intraoperative blood loss, intraoperative fluoroscopy time, and hospital stay (p>0.05). The study group yielded a more favorable outcome with regard to the Harris-Hip-Score (HHS) scores, HHS excellent- and-good rate, and Flynn scores satisfaction rate than the control group (p<0.001 or 0.05). The intracavitary pressure of the knee joint of the two groups presented a gradual decline with time, with remarkably lower results in the study group compared with the control group at 8 weeks and 16 weeks after the surgery (p<0.05), and differences at 24 weeks after the surgery did not come up to the statistical standard (p>0.05). Patients experienced fewer postoperative complications after locking plate fixation, as compared to those who received K wire treatment (p<0.05). Compared with the control group, the fracture union rate of diabetic children in the study group was significantly higher at 12 weeks, 16 weeks, and 20 weeks after surgery, respectively (p<0.05), while there was no significant difference between the two groups at 24 weeks and 28 weeks (p>0.05). CONCLUSIONS: The distal femur 90° locking plate fixation for diabetic children with SFF obviates the need for plate shaping and ensures firm fixation, with biomechanical design, promising efficacy, and few complications. The distal femur 90° locking plate fixation has better efficacy for children with diabetes. It shows great potential as the treatment of choice for diabetic children with SFF. [ABSTRACT FROM AUTHOR]

Background: Distal forearm fractures are widespread in children and adolescents. The radial transition zone between diaphysis and metaphysis is not universally defined. Still, diametaphyseal radius fractures (DMRF) are prone to complications, and a commonly agreed standard for their treatment has yet to be established. Methods: We report on 59 children with unstable DMRF treated with a transepiphyseal, percutaneous, intramedullary K-wire (TEPIK) from 2010 to 2020. After fracture reduction, the patient's hand is held in palmar flexion. Next, a 1.8-2mm K-wire is inserted just beyond Lister's tubercle through the epiphysis and advanced, crossing the physis straight into the medullary cavity of the diaphysis. We report radiographic geometry before and after the treatment, operation times, course of treatment, functional results, and complications. Results: We saw no loss of reduction and no remaining functional deficits. Surgical trainees performed this technique in 71.2%. The mean operating time was 29 minutes. Percutaneous K-wires could be removed without anesthesia or sedation in our outpatient clinic in 81.4%. We saw two refractures after a second high-energy trauma and seven K-wires that migrated subcutaneously because they were cut too short. Conclusion: TEPIK is a quick and easy treatment for unstable DMRF. It provides safe management with a single, definite surgery if metal removal of an ulnar ESIN is unnecessary. This study is one of the most extensive series on the surgical treatment of DMRF reported in the literature and presents successful results of TEPIK in the treatment of unstable DMRF.

ObjectiveIn the past, obviously displaced lateral condyle fractures of the humerus in children were treated satisfactorily with open reduction and internal fixation (ORIF). However, in recent years, more studies have mentioned closed reduction and percutaneous pinning (CRPP) of these fractures.MethodsIn this retrospective investigation, the radiographic and clinical results of patients with these fractures that were initially managed with CRPP were newly classified. We classified these fractures into three groups according to the degree and pattern of fracture displacement as identified on four radiographic images. In Type I, the fracture is unstable and displacement is ≥2 mm; In Type II degree I, the fracture is unstable and displacement is >2 mm, with single rotation of fragment; In Type II degree II, the fracture is unstable and displacement is >2 mm, with single rotation of fragment, with rotation of fragment and antero-proximal displacement; In Type III, the fracture is unstable and displacement is >2 mm, with posterior dislocation of elbow joint. We also designed an algorithm for closed reduction of these fractures according to this new classification.ResultsWe retrospectively analyzed the radiographic and clinical results of 37 unstable fractures (in 22 boys and 15 girls) that were treated with closed reduction. Twenty-one of 25 (84.0%) type I fractures, which could have been reduced to within 2 mm of residual displacement, were treated with closed reduction and pinning with 2 or 3 Kirschner wires (K wires). Three of 5 (60.0%) type II degree I, 3 of 4 (75.0%) type II degree II, and 3 of 3 (100%) type III fractures were treated with CRPP. In 4 of 25 (16.0%) type I, 2 of 5 (40.0%) type II degree I and 1 of 4 (25.0%) type II degree II fractures, closed reduction failed, so ORIF was implemented. There were no complications, such as nonunion, osteonecrosis of the capitellum, superficial or deep infection, malunion, cubitus varus or valgus, or early physeal arrest.ConclusionAlthough the management of type III fractures may not be more difficult than type II fractures with a rotated fracture fragment, as elbow dislocations are usually easy reducible. This retrospective study showed that type III fractures should not be ignored as a lateral condyle fracture that can be cured with CRPP and that lateral humeral condyle fractures with obvious displacement and rotation can be initially treated with CRPP to achieve satisfactory recovery of the elbow. Kirschner wire (K wire) fixation is recommended to avoid reoperation or anesthesia for hardware removal.

Classically, one of the more common treatment options for rigid hammertoe correction consists of end-to-end arthrodesis stabilized by temporary Kirschner wire (K-wire) fixation maintained until osseous consolidation or complication necessitating premature removal. However, single K-wire fixation allows for axial rotation which results in loss of compression at the arthrodesis site. To counteract this, intramedullary implants were designed to provide fusion site stability in all planes negating extra-skeletal extension of the wire. Nevertheless, manual pressfit implants arguably offer less reliable positioning of the fusion site in a true end to end orientation due to variation in intramedullary stem placement compared to direct visualization with dorsal plating. Larger diameter implants create an osseous void at the bony interface reducing the potential of true bony union. Hammertoe implant failure poses a unique and challenging salvage scenario which can ultimately end in amputation. Extramedullary fixation is uniquely designed to merge both benefits of K-wires and intramedullary implants while eliminating inadequacies of each. A total of 100 patients who underwent 150 rigid hammertoe corrections with an extramedullary implant were retrospectively reviewed. The mean postoperative follow-up was 12.6 months (range 12-18 months). Overall, 94 of 100 patients (94%) achieved radiographic union, defined by 2 or more bridged cortices at the arthrodesis site without signs of hardware breakage or signs of lucency across one or more fusion sites at a mean 8.8 weeks (range 7-10 weeks). This study demonstrated excellent results in regards to postoperative arthrodesis when utilizing an extramedullary implant for hammertoe deformity correction. This device minimizes osseous deficit by extramedullary application, all while augmenting intramedullary K-wire fixation. [ABSTRACT FROM AUTHOR]

Purpose: The most common hand fracture in children is seen at the base of the proximal phalanx. This study aims to compare clinical outcomes of single versus double Kirschner wire pinning for pediatric proximal phalanx base fractures. Patients and Methods: The retrospective study enrolled patients who underwent closed K-wire pinning for proximal phalanx base fractures from January 2016 to February 2022. We divided patients into two groups based on the number of K-wire inserted (single versus double). Demographics, removal of implant, complication rate were analyzed. Patients were asked to answer the Michigan Hand Outcomes Questionnaire (MHQ) by telephone. Data including fracture type, diaphyseal axis-metacarpal head angle (DHA) and Total Active Flexion Scale (TAFS) were analyzed. Results: This study included 37 pediatric patients with proximal phalanx base fractures, treated with either single (n = 10) or double K-wire (n = 27) fixation. The mean operation time was significantly shorter for the single K-wire group. No significant differences were observed in complication rates, TAFS, implant removal times, MHQ, or pre- and post-operative DHA between the two groups. Conclusion: The single K-wire technique demonstrates similar effectiveness to the double K-wire technique in treating pediatric proximal phalanx base fractures, with the added benefit of shorter operation time. Therefore, the choice between using one or two K-wires should be determined based on the surgeon's proficiency and preference. [ABSTRACT FROM AUTHOR]

BACKGROUND: Effective surgical fixation should be performed for patients with ulnar coronoid fractures with unstable elbow joint. When the coronoid fracture fragment is large, there are more internal fixation materials, such as microplates, steel wires, screws, and anchors. However, when the fracture fragment is small, choosing the appropriate internal fixation device is a difficult problem OBJECTIVE: To explore the stability of modified threaded Kirschner wire in the treatment of ulnar coronoid process fracture using finite element analysis. METHODS: Thin layer 128-row CT was applied to scan the elbow of one healthy male volunteer. Ulnar coronoid process Regan-Morrey II type fracture model was established using the software such as Mimics 21.0. The models of ordinary Kirschner wire (1.2 mm) and modified threaded Kirschner wire (1.2 mm) were established by Unigraphics NX 10.0 software. The above three kinds of model data were imported into ANSYS Workbench software to generate the ulnar coronoid process Regan-Morrey II type fracture model of ordinary Kirschner wire fixation (ordinary wire group) and the ulnar coronoid process Regan-Morrey II type fracture model of modified threaded Kirschner wire fixation (threaded wire group). The anti-pull-out simulation test, anti-horizontal displacement simulation test and anti-rotational displacement simulation test were carried out for both groups of models. The displacement and stress changes of fracture blocks were recorded, and the variation curves were plotted and Mises stress nephogram was obtained. RESULTS AND CONCLUSION: (1) In the anti-pull-out simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 3.96 mm and 93.2 N, respectively. The maximum displacement and the maximum stress of threaded wire group were 0.20 mm and 177.6 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (2) In the anti-horizontal displacement simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 0.55 mm and 199.2 N, respectively. The maximum displacement and maximum stress of the threaded wire group were 0.05 mm and 573.7 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (3) In the anti-rotational displacement simulation test, the maximum displacement and the maximum stress of the ordinary wire group were 3.75 mm and 332.2 N, respectively. The maximum displacement and the maximum stress of the threaded wire group were 0.25 mm and 225.6 N, respectively. The stress distribution of the threaded wire group was slightly more concentrated than that of the ordinary wire group. (4) The experiment proves that the modified threaded Kirschner wire has better stability in fixation of ulnar coronoid process fracture [ABSTRACT FROM AUTHOR]

Background: Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods: A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results: Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P =.05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions: This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs. [ABSTRACT FROM AUTHOR]

Background: The primary constraint to the dislocation of an acromioclavicular (AC) joint is its ligaments. They prevent vertical and horizontal translations in the joint. Reconstruction of these ligaments is of prime importance for restoring the AC joint. There is uncertainty regarding the surgical treatment protocol for Rockwood's type III injury. Patients and Methods: We report a prospective cohort study on 20 patients aged between 15 and 45 years, presenting with Rockwood type III or higher rank of AC joint dislocation for open double-tunnel anatomical reconstruction of AC joint using autogenous semitendinosus graft. Patients were evaluated at the end of follow-up of 2 years using the Constant–Murley outcome scoring system. Results: Clinical and radiological evaluation performed revealed excellent results in 15, good in three, and fair in two, with no poor results recorded. Conclusion: Open double-tunnel reconstruction with semitendinosus graft is a vital technique for Rockwood type III or higher grade of AC joint dislocation management to deliver a pain-free shoulder with good strength, well-retained range of movements, and near normal regain of activities.

Background: Hand fractures can be treated conservatively or surgically, depending on the severity, location, and type of fracture, as in conservative management chance of nonunion, malunion, and stiffness is more if it is displaced or angulated fracture. Various modes of treatment have been used which include K-wire fixation, mini plates, and external fixator application. A modified form of mini-external fixator devised in India is Joshi's External Stabilization System (JESS). Aim: This prospective study was conducted to compare the functional and radiological outcomes following metacarpal/phalangeal fracture fixed with either K-wire or JESS. Materials and Methods: Forty patients with hand fractures (58 fractures – 18 metacarpal and 40 phalanges) were prospectively studied. Twenty patients underwent K-wire fixation and 20 were fixed with JESS, functional and radiological outcomes were assessed, grip strength using dynamometer, visual analog scale (VAS) score, disabilities of the arm, shoulder, and hand (DASH) score, range of motion (ROM) using the American Society for Surgery of the hand scale, tip pinch strength. Student's t-test, Wilcoxon test, Fisher's exact test, and Chi-squared test were used. Results: At 6 months' follow-up, patients fixed with either of the fixation modality showed statistically significant improvement in different outcome variables such as ROM (P < 0.001), quick DASH score (P < 0.001), VAS score (P < 0.001), tip pinch strength (P < 0.001), and hand grip (P < 0.001). All the fractures united at an average 6 weeks. Functional outcomes were excellent in closed fracture fixed with either JESS or K-wire and good to moderate in open injuries. However, overall comparison between K-wire and JESS, no significant difference in these outcome measures was found. Conclusions: K-wires as well as JESS both provide adequate stability and satisfactory results in fractures of the metacarpal and phalanges. This study could not find the superiority of JESS over traditional K-wire fixation.

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BACKGROUND: The anterior cruciate ligament (ACL) is an important ligament of the knee joint. Avulsion fracture of the tibial insertion point of the ACL accounts for 14% of all ACL injuries. However, no gold standard approach for treating ACL avulsion fractures exists. OBJECTIVE: This study aimed to evaluate the clinical effect of the treatment of ACL avulsion fracture with gate-shaped Kirschner wire fixation via arthroscopy. METHODS: Clinical data of 46 patients (male:female, 1:1.3; age, 3 5. 3 ± 8. 2 years) with ACL avulsion fracture who were treated with gate-shaped Kirschner wire fixation via arthroscopy in the People's Hospital of Zhongjiang County from February 2018 to March 2021 were collected. The clinical effect was retrospectively analyzed using preoperative and postoperative joint range of motion (ROM), Lysholm score, and International Knee Documentation Committee (IKDC) score. RESULTS: After the operation, the ROM (mean ± standard deviation, 7 2. 2 2 ± 2 7. 9 2 ∘ and 1 3 7. 7 8 ± 7. 3 8 ∘ , P < 0. 0 5), Lysholm score (4 5. 8 1 ± 1 0. 9 4 ∘ and 9 3. 0 4 ± 9. 5 8 ∘ , P < 0. 0 5), and IKDC score (4 3. 8 9 ± 1 1. 1 6 ∘ and 9 0. 2 6 ± 5. 8 6 ∘ at the last follow-up, P < 0. 0 5) significantly increased. CONCLUSIONS: The Kirschner wire fixation technique via arthroscopy displayed good therapeutic efficacy, was simple and effective, and is worth recommending for treating ACL avulsion fractures. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aims to find the optimal arrangement of the Kirschner wire (K-wire) in the sagittal plane for fixation of a pediatric lateral condylar humeral fracture (Milch type II) by using finite element analysis (FEA).MethodsA model of lateral condyle fracture in a 6-year-old boy was developed, and an XYZ coordinate system was established based on this model. The YZ plane was defined as the sagittal plane to investigate the impact of the angle formed by the first and second K-wires on stability. Two configurations were studied for each angle: parallel and divergent. Evaluation indicators included the maximum displacement of the fracture fragment and the maximum von Mises stress in the pins and bone.ResultsThe model with a −60° angle showed the best performance in both evaluation indicators. The parallel and divergent pin configurations had different performances in each group. The displacement results for negative angles were similar, and this result was better than those for positive angles.ConclusionWe successfully created a model of pediatric lateral condyle humerus fracture (Milch type II) and performed K-wire fixation with varying sagittal plane configurations, combined with FEA. Our findings demonstrate that the angle of −60° between the two pins in the sagittal plane provided the highest level of stability, with divergent configurations proving superior to parallel pinning at this angle.

BackgroundThe bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro's method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro's method and achieve better clinical efficacy.MethodsWe examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement.ResultsThe 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed.ConclusionThe application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.

ObjectivesInappropriate treatment of Closed displaced phalangeal neck fractures (CDPNF) in children usually leads to poor outcomes.This study was to evaluate the clinical outcomes of closed/open reduction, age, and different types of fracture and Kirschner wire (K-wire) fixation in the treatment of CDPNF.Materials and methodsParticipants: Sixty patients (male, 46 and female,14; right-handed, 35 and left-handed, 25; mean age, 7.9-years-old [range, 1.0–14.5 years]) who had CDPNF were included. Preoperative x-rays showed that the fractures were displaced and exhibited obvious deformities. Interventions: First, reduction (four cases of open reduction and 56 cases of closed reduction) was performed followed by percutaneous K-wire fixation (cross fixation, 24 cases; longitudinal and slanting fixation, 17 cases; homolateral fixation, four cases; and single longitudinal fixation, 15 cases,) and immobilized by cast. x-ray examination following removal of the K-wires showed that the fractures were healed; the criteria for fracture healing were callus formation and the absence of fracture lines. Clinical outcome and radiographs between groups were compared.ResultsAccording to the visual analogue scale, the pain scores were excellent. According to the Al-Qattan Grade system(AGS),all the patients presented with closed, type II phalangeal neck fractures,the results were excellent in 36 cases (36/60, 60%), good in 15 cases (15/60, 25%), fair in 5 cases (5/60, 8.3%) and poor in 4 cases (4/60, 6.7%). There were significant differences in different fracture type groups (P = 0.013*), operation age groups (P = 0.025*) and open/closed reduction groups (P = 0.042*). There was no significant difference in K-wire fixation type groups (P > 0.05).ConclusionsPatients with open reduction, the more serious fracture type, the older at the operation, were more likely to have poor AGS result. Different K-wire fixation types for CDPNF in children had the same satisfactory results.

Background/Aim: Atlantoaxial subluxation (AAS) is a congenital or traumatic condition that often requires surgical stabilization. Surgery is performed via a ventral or dorsal approach. A ventral approach is challenging in toy breed dogs due to their small-sized bones. Reducing AAS by orthopedic wire via a dorsal approach can cause iatrogenic spinal cord damage. Due to these limitations, a Kishigami atlantoaxial tension band (Kishigami AATB) that remains in the epidural space has been devised. Similar to the Kishigami AATB, the present study developed a modified dorsal wiring method and evaluated it in toy breed dogs with AAS. Materials and Methods: Medical data of toy breed dogs with AAS that underwent surgical stabilization using the modified dorsal wiring method from 2017 to 2020 were retrospectively reviewed. Results: A total of 10 dogs were analyzed. Regarding the history of these dogs, six dogs had congenital AAS, and the remaining four dogs had traumatic AAS. Evaluation via computed tomography was available for five dogs, of which two dogs were identified as having incomplete ossification of their atlas. Although four dogs required a revision surgery because of recurrence of clinical signs or fracture of the atlas, final functional improvement was achieved in nine dogs. One dog showed worsened neurological status that led to death. Conclusion: Clinical results with the modified dorsal wiring method were similar to those with the Kishigami AATB. The modified dorsal wiring method is versatile as it could be applied to various shapes of dogs' atlas. Considering the shape of the atlas, it is recommended to apply the implant as far from the midline of the dorsal arch as possible to avoid fractures. With selection of suitable patients, this modified dorsal wiring method can be applied to dorsal stabilization of AAS in toy breed dogs. [ABSTRACT FROM AUTHOR]

Objective: Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool using Kirschner wire. We aimed to use this tool for flap-lifting in modified areola approach endoscopic thyroidectomy and compare it with conventional CO2 insufflation. Methods: In a prospective study, patients who underwent endoscopic thyroidectomy via modified areola approach were randomly assigned into gasless (n = 20) or CO2 groups (n = 22). Pre-operative variables included age, gender, tumor diameter, and clinical diagnosis. Intra-operative hemodynamic monitoring included mean arterial pressure, heart rate, pulse oximetry, end-tidal carbon dioxide (ET-CO2) and arterial pH. Other intraoperative details included total operative time, operative blood loss, conversion from endoscopic surgery to open surgery, intra-operative events, and endoscope video score. Postoperatively, the hospital stay, drainage volume, and complications were recoded. Results: Patient characteristics were not different between the two groups. During the operation, ET-CO2 levels were significantly higher in the CO2 group (P < 0.05), whereas arterial pH levels were significantly lower (P < 0.05). The CO2 group had longer operation time and higher endoscope clarity VAS score than gasless group. Hospital stay, drainage volume, and postoperative complications did not differ significantly between the two groups (P > 0.05). Conclusions: The gasless endoscopic thyroidectomy we performed via our Kirschner wire hook was safe, feasible, and yielded good results. [ABSTRACT FROM AUTHOR]

To compare the mid-term clinical results of lag screw and Kirschner wire fixation(KWF) for close reduction in triplane distal tibia epiphyseal fracture. A retrospective analysis of 25 cases of triplane fractures of the distal tibia treated in our department from Jan 2017 to Dec 2019 was performed, Lag screw fixation(LSF) was used in 14 cases and Kirschner wire fixation in 11 cases, the clinical results were evaluated by premature epiphyseal closure(PPC) rate, the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-hindfoot foot scoring system, the lateral distal tibial angle (LDTA) from X-ray. All the 25 children were followed up for a mean of 34(ranging 26–52) months. AOFAS scores improved from a mean of 33(ranging 29–43) pre-op, to 82(ranging 77–88) at three month follow up, to 92 (ranging 88–98) at last follow-up in all 25 cases. Till last follow up there was no cases premature physeal closure in LSF group but 4 cases in KWF group, LDTA in both groups at last follow up shows no ankle varus or valgus deformity, and the ankle joint function was not limited in all cases. Lag screw and Kirschner wire fixation methods can both achieve good clinical effects for triplane distal tibia epiphyseal fracture. Lag screw fixation provide lower PPC rate but Kirschner wire fixation save one anesthesia and surgery. [ABSTRACT FROM AUTHOR]

Proximal interphalangeal (PIP) joint fusion with Kirschner (K) -wire fixation remains a popular strategy for hammertoe correction. This study was performed to evaluate the effect of length of wire fixation on clinical outcomes. A retrospective review of all hammertoe reconstructions by a single surgeon was performed. Wire length was chosen at the surgeon's discretion. Outcomes were assessed with metatarsophalangeal (MTP) congruency, pin complications, and PIP union. 157 toes underwent reconstruction. Seventy had wires that spanned the MTP and 87 that did not. Wire breaks were significantly more common with longer wire fixation (P =.024). MTP incongruency was significantly more common in the MTP group (P =.014). Pin breakage was rare and only occurred in the MTP group. MTP incongruence was significantly more common in the MTP group but may not reflect surgical technique. PIP union was more common with longer wire fixation but is not clinically significant. III [ABSTRACT FROM AUTHOR]

Background: Intra-articular distal radius fractures with small volar lunate facet fragments can be challenging to address with volar plate fixation alone. Volar locked plating with supplementary spring wire fixation has been previously described in a small series but has not been further described in the literature. We hypothesized that this technique can provide adequate fixation for volar lunate facet fragments smaller than 15 mm in length, which are at risk of displacement. Methods: We completed a retrospective chart review (2015-2019) of patients who underwent volar locked plating with the addition of supplementary spring wire fixation for intra-articular distal radius fractures with a volar lunate facet fragment (<15 mm). Postoperative radiographs were assessed to evaluate union, evidence of hardware failure, escape of the volar lunate facet fragment, and postoperative volar tilt. Clinical outcome was assessed with wrist flexion/extension, arc of pronosupination, and Quick Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH) scores. Results: Fifteen patients were identified, of which all went on to fracture union. There were no hardware failures or escape of the volar lunate facet fragment at final follow-up. One patient underwent hardware removal for symptoms of flexor tendon irritation. The mean wrist flexion was 59°, wrist extension was 70°, pronation was 81°, and supination was 76°. The mean QuickDASH score was 18.5. The mean postoperative volar tilt was 3.6°. Conclusions: Supplementary spring wire fixation with standard volar plating provides stable fixation for lunate facet fragments less than 15 mm. This technique is a safe and reliable alternative to commercially available fragment-specific implants. [ABSTRACT FROM AUTHOR]

Objective The study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow‐“8” suture fixation (AS) and K‐wire fixation in patients with distal pole patellar fractures. Methods Twenty‐eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow‐“8” suture fixation (AS group) was applied in 10 patients and 18 patients underwent K‐wire fixation (K‐wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K‐wire group, with comparable demographic characteristics. All patients underwent regular follow‐up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture. Results A total of 28 eligible patients were included in this study. The mean follow‐up was similar for the AS and the K‐wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The final follow‐up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion–extension angle was slightly better in the AS group than in the K‐wire group. The Bostman patella fracture functional score of AS group were better than K‐wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K‐wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re‐operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation. Conclusions Anchor and Krackow‐“8” suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures.

Kirschner wire is a widely used implant in orthopedics, with migration being a typical problem following internal fixation. Subcostal wire migration might result in catastrophic problems such as penetration of the heart, lungs, trachea, big blood vessels, or abdominal cavity. Every orthopedic surgeon must be vigilant and mindful of the potential hazards of wire migration. a 45-year-old Indonesian male was referred from another hospital. 1 year prior, the patient underwent internal fixation of the left clavicle. 2 weeks before admission, the patient complained of stabbing pain in the left shoulder area. An X-ray examination revealed a broken end wire in the left infraclavicular area. Immediate wire-extraction surgery was planned. An X-ray and CT scan showed that the wire had migrated into the left lateral side of the 9th subcostal space and was heading inferiorly. The Thoracic and Cardiovascular Surgery Department carried out the wire evacuation. The wire was successfully removed without any concern. Previous studies have suggested that wire migration can occur due to muscular activity, respiratory motion, gravity, and upper-extremity movement. Wire migration is a condition that can occur following shoulder fixation, especially in comminuted fractures that typically use K-wires to stabilize the fragments. Upon the detection of wire migration, prompt evacuation should be conducted to mitigate the severity. In cases of wire migration, orthopedic surgeons should pay special attention. Actions that can be taken to prevent wire migration are to: bend the wire, use a threaded wire, and remove it quickly after callus formation. • Wire migration is a frequent complication following the internal fixation of clavicle fractures. • Motion around fracture site can cause K-wire migration, bending with an angle of 180 degree would be an anchor for K-wire to prevent migration • A threaded wire, such as a Schanz screw, can be used to improve bone traction and reduce the likelihood of migration. • The K-wire should be removed immediately if fracture or migration is detected, regardless of the absence of symptoms. [ABSTRACT FROM AUTHOR]

BackgroundSupracondylar femoral fractures (SFFs) are uncommon in children but can cause several abnormalities. Although several methods have been employed to treat these fractures, no accepted standard has been established.ObjectivesTo investigate the clinical and radiographic outcomes of displaced SFFs treated with Kirschner wires (K-wires) and hip spica casts in children aged 4–10 years.MethodsWe retrospectively reviewed 22 displaced SFFs (mean age, 6.7 years; range, 4–10 years) in patients who underwent surgical treatment with K-wires and hip spica casts. The patients were followed-up frequently, radiographically and clinically between January 2014 and February 2019. Postoperative healing and functional results were elevated according to the radiographic and clinical measures.ResultsFifteen boys and seven girls were included in this study. All patients except two (91%), underwent closed reduction and stabilization of the fractures. The mean follow-up duration was four years (range, 2–5 years). All fractures showed clinical and radiological evidence of union 4–8 weeks after surgery. At the most recent check-up, all patients reported being pain-free and had returned to normal activities. The mean Knee Society Score was 95.41 at the final follow-up. According to the radiologic criteria, 18 of the 22 patients (81.8%) obtained excellent results, 3 (13.6%) had good results, 1 (4.5%) had a fair result, and none had poor results.ConclusionSatisfactory clinical and radiological results can be expected in children aged 4–10 years using a combination of K-wires and hip spica cast fixation.

PurposeTo evaluate the long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint.MethodsFrom July 2016 to September 2021, 21 patients with fracture-dislocation of the fifth carpometacarpal joint were treated with trans-articular plate combined with Kirschner wires internal fixation. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, the time between injury and surgery, the range of motion of the bilateral wrist in flexion, extension, radial deviation and ulnar deviation, grip strength of each side, the time of return to work, and follow-up time were recorded. The QDASH score and Cooney wrist function score were used to evaluate the postoperative function. The VAS system was used to evaluate postoperative pain.ResultsThe follow-up time was 37.0 ± 19.0 months and the time between injury and surgery was 1.3 ± 0.5 days. In the injured side and the contralateral side, the range of motion of the wrist flexion were 58.3 ± 4.0° and 60.5 ± 3.1°, the range of motion of the wrist radial deviation were 25.7 ± 3.3° and 26.9 ± 2.9°, the range of motion of the wrist ulnar deviation were 28.1 ± 3.7° and 29.5 ± 3.1° respectively with no significant difference. The range of motion of the wrist extension (54.0 ± 3.4°) in the injured side was smaller than that in the contralateral side (56.7 ± 3.7°) with significant difference. The grip strength of the injured side and the contralateral side were 96.1 ± 9.5 LB and 100.7 ± 9.7LB respectively with no significant difference. The QDASH score was 3.8 ± 1.8, Cooney wrist function score was 94.5 ± 4.2, VAS score was 1.0 ± 0.8 and the time of return to work was 5.1 ± 0.9 weeks. In the 21 cases, no postoperative complications such as incision infection, failure of internal fixation, fracture nonunion or fracture malunion occurred.ConclusionThe method of trans-articular plate combined with Kirschner wires is one of the alternative treatments for the fracture-dislocation of the fifth carpometacarpal joint. The long-term follow-up results were satisfactory.

BackgroundPatella fractures that require surgery are conventionally treated using Kirschner wires (K-wires) and stainless steel wires. In recent years, the nonabsorbable polyester has been reported to have excellent outcomes clinically. Therefore, the goal of our study was to evaluate the effects of Kirschner wires combined with 5-Ethibond on treating patellar fractures.MethodsFrom July 2018 to January 2022, 22 patella fracture patients were treated with Kirschner wires combined with 5-Ethibond. Radiographs of the knees were used to evaluate fracture healing and hardware complications. The clinical results were evaluated through the functional score, knee joint range of motion (ROM), and Bostman patella fracture functional score.ResultsThe average age of patients was 57.4 ± 11.9 (range 33–74) years. The mean follow-up time was 15.2 ± 7.6 (range 4–36) months. The mean operation time was 56.8 ± 8.7 (range 45–80) min. The entire patients had bony union at an average of 10.5 ± 1.9 (range 8–14) weeks. At the final follow-up, the mean range of postoperative ROM was 123.4° ± 14.6° (range 95°–140°), and the functional score was 28.7 ± 1.2 (range 26–30) points. No patient exhibited internal fixation failure, and no symptomatic implants or skin complications were recorded.ConclusionsThe fixation approach using K-wires combined with 5-Ethibond has a lower complication rate and delivers superior clinical results. This research reveals that such technology is a safe and prospective substitute for conventional metal fixation approaches.