Closed Reduction and Fixation of Metatarsal Head and Neck Fractures Using Antegrade Intramedullary K-wire (6 Cases Report) / 대한족부족관절학회지

Metatarsal head and neck fractures are injuries that often result from a direct blow of a heavy objects to the metatarsal head. The head is often impacted or displaced to the plantar aspect that if not treated may cause malunion which later induces painful plantar calluses. If the fracture fragment is large enough, closed reduction may be successfully performed, but when the fragment is small or closed reduction is unsuccessful, open reduction is needed. We present our reduction and fixation technique for the metatarsal head and neck fractures using antegrade intramedullary Kirschner wire (K-wire) without opening the fracture site or infringing the metatarsophalangeal (MTP) joint which allows immediate motion of the joint and partial weight bearing in a stiff soled shoe.

The Effect of Prophylactic Cable Fixation for Prevention of Femoral Fractures in Hemiarthroplasties

PURPOSE: The purpose of this study was to assess the effect of a prophylactic cable fixation for prevention of femoral fractures in cementless bipolar hemiarthoplasties. MATERIALS AND METHODS: Forty-eight cementless bipolar hemiarthroplasties with prophylactic cable fixations on the femur were performed in patients >65 years of age between January 2004 and August 2008 (group 1). The control group which did not undergo prophylactic cable fixation included 48 cases (group 2). The mean age was 75.4 years (group 1) and 73.6 years (group 2). The patients were followed up for an average of 19.1 (group 1) and 18.3 months (group 2). The intra-operative fracture rates were compared. Additionally, operative time, estimated blood loss (EBL), and length of hospital stay were compared. Radiologic assessment for stem stability was performed. Clinical assessment was evaluated by the thigh pain and Jensen's functional score, and Parker & Palmer's mobility score. RESULTS: There was no fractures in the cabled group (1), and 4 fractures (8.3%) in the control group (2; p=0.041). The mean operative time was 172 minutes (1) and 162 minutes (2), the EBL was 866 cc (1) and 855 cc (2), and the duration of admission was 36 (1) and 35 days (2), respectively. Radiologically, subsidence was 1.59 mm (1) and 1.67 mm (2). Clinically, one (1) and two (2) thigh pains were recorded and the functional score of Jensen was 2 (1) and 2.2 points (2), and the mobility score of Parker and Palmer was 5.2 (1) and 5.3 points (2), respectively. CONCLUSION: Prophylactic cable fixation is effective for reducing intra-operative femoral fractures.