SURGICAL OUTCOME OF PERCUTANEOUS PIN FIXATION OF PROXIMAL THIRD FRACTURE OF ULNA IN MONTEGGIA FRACTURE DISLOCATION IN CHILDREN

Introduction: Monteggia fracture dislocation is a rare and severe injury of both paediatric and adult forearm and elbow.It was described for the first time by GIOVANNI BATTISTA MONTEGGIA in 1840,who reported two cases of fracture of the proximal third of ulna with conjoint ventral dislocation of the proximal radius. In 1967 JOSE LUIS BADO published a classification scheme of monteggia lesion based on the direction of the dislocation of radial head,this anatomical classification was suitable for both adults and children .Monteggia fracture dislocations constitute about 1% – 2% of all forearm fractures . Monteggia fractures remain challenging paediatric injuries because of difficulties in diagnosis , propensity for instability and complexity of late reconstruction. More than 50% of these fracture dislocation are misdiagnosed in children and leads to dysfunction of elbow joint. The fixation and stabilization of ulna fracture will automatically reduce the radial head dislocation. The aim of this study is to evaluate a group of paediatric patients with Monteggia lesion and its equivalents treated by percutaneous fixation of proximal third ulna fracture with k wire after reduction of fracture ulna and dislocated radio capitular joint under c-arm guidance. Materials and methods We treated 18 children of age ranging between 6 to 12 years with Monteggia fracture dislocation of the forearm with percutaneous fixation of the proximal third fracture of ulna with k wires after reduction of fracture and dislocated radio-capitular joint under C-arm control.The elbow is immobilized in fiexion with plaster of paris slab and bandage for a period of four weeks and mobilization of elbow is started after four weeks. By the end of 8 weeks K-wire removed. All fractures are fixed with in twenty four hours. The results Results : are good, there is no incidents of any stiffness. Range of movements of elbow and forearm are well preserved.The function of elbow and forearm are satisfactory.Conclusion:A good outcome after Monteggia injury in a child requires early diagnosis and prompt stable anatomical reduction of the ulna fracture and this can be achieved through stabilization of ulna by percutaneous intramedullary k wires.

Comparative Study Of Surgical Correction Of Congenital Talipes Equino Varus Deformity With And Without Internal Fixation (using K-wires)

Congenital Talipes Equino Varus is one of the most common congenital deformity which occurs in 1/1000 live birth worldwide. Regarding management of this clubfoot ,most orthopaedic surgeons agree that approach management of children with congenital talipes equino varus deformity of foot should begin with conservative measures i.e, manipulation and serial casting in position of correction. One or more surgical procedures are often required in patients who had incomplete correction , recurrent deformity , syndromic correction and after repeated manipulation and casts. Recurrence is a common problem following the club foot surgery one of the reason for recurrence can be redisplacement of tarsal bones .This study aims to compare prospectively the functional and cosmetic outcome of two groups of club foot-one in whom tarsal joint were fixed with k-wires after doing posteromedial soft tissue release and one in whom tarsal joint were not fixed after soft tissue release .To know the incidence of congenital talipes equino varus with respect to age and sex predilection over a period of two years which were admitted between October 2017 to October 2019, 28 idiopathic club foot in 20 children range from 4 months to 3 years were treated out of 20 cases 12 were males,8 were females.8 patients had bilateral deformity out of 12 unilateral deformities 8 were on right side and 4 were on the left side. Male and female ratio 1.5:1 and unilateral to bilateral 1.5 :1.In 12 feet turco's posteromedial soft tissue release and internal fixation of tarsal joints with k-wires was done in 16 feet only turco's posteromedial soft tissue release was done. The period of follow up ranges from 6 months to 2 years

Functional Outcome of Paediatric Diaphyseal Fractures of Femur Treated with Closed Reduction and Multiple K Wire Fixation.

Background: Diaphyseal fracture of the femur in children is one of the common causes of paediatric morbidity. These fractures in children above the age of five years, depending upon the fracture personality, can usually be managed satisfactorily using different intramedullary implants, including Kirchner wires, Rush nail, as well as extramedullary implants using various combinations of plates and screws. Each of these methods of fracture fixation has its own merits and demerits. The current study is aimed at assessing the efficacy of internal fixation of these fractures using closed reduction and percutaneous ‘K’ wire fixation. Methods: Twenty six (n=26) children with a mean age of 7.2 years (range 5-14 years) were treated using closed reduction and multiple percutaneous K wire fixation under image intensifier. The minimum follow up period was twelve months. The final clinical and radiological assessment of patient was done at the end of one year. Three patients (n=3) were lost to final follow-up and were excluded from the final statistical calculations. Results: Twenty one fractures (n=21) united at an average time interval of 4.1 months (range 3- 6.5 months). Two patients had delayed union and one had malunion. Superficial wound infections were seen in two (8.7%) patients. Impingement of bent k wires was felt by another two (8.7%) patients. Stiffness of the knee joint was seen in three patients (13%) during follow-up. Out of three (n=3) patients with knee stiffness two responded well to vigorous physiotherapy programme, while one (n=1) patient had limited knee range of motion even at the final follow-up. Malunion was seen in one (n=1) patient. Conclusion: Closed reduction and percutaneous K wire fixation is a safe, economical, technically non-demanding and highly efficacious technique for the treatment of paediatric femoral diaphyseal fractures.

Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly

This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1), who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS) plate and 30 patients(Group 2) who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS) and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100) in Group 1 and - 76.4 points(range:56-100) in Group2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10) in Group 1 and 3.8(range:0-10) in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-ofmotionexercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.

Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires

PURPOSE: To evaluate the radiologic and clinical results of percutaneous transverse fixation with K-wires for 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January 2007 and September 2010, 18 patients with a 5th metacarpal neck fracture, who underwent operative treatment, were included in this study. The surgical method was percutaneous transverse fixation using K-wires. We evaluated fracture angulation in oblique radiographs preoperatively, postoperatively, and at final follow-up, and used SPSS to perform statistical analysis. We also performed clinical evaluation using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: All of the 18 cases were completely united, and in the oblique radiographs, the angulation was corrected from 50.69degrees to 11.68degrees. The average difference between postoperative and final follow-up angulations was 0.14degrees, which was statistically insignificant. Clinically, the DASH score was 1.030 and no complications were observed. CONCLUSION: Percutaneous transverse fixation using K-wires could be one of the best ways to treat a 5th metacarpal neck fracture because of its simple method and low rate of complications.

Open Reduction and K-Wire Fixation for Mallet Finger Fractures

PURPOSE: To evaluate the results of open reduction and K-wire fixation in patients with a displaced dorsal intraarticular fracture of the distal phalanx. MATERIALS AND METHODS: From May 1999 through April 2008, 32 fingers (32 patients) with a mallet finger fracture involving one-third or more of the articular surface and/or a subluxated distal phalanx were included. While maintaining the reduction of the dorsal fracture fragment obtained by open method, two K-wires were introduced to fix the fragments and the third K-wire to fix the distal interphalangeal joint. Clinical results were investigated at an average follow-up of 13 months. RESULTS: Radiologically, solid bony union was observed in all fingers at an average of 6.5 weeks after the operation. The final results showed exellent in 17 patients(53.1%), good in 14 patients(43.8%) and fair in one(3.1%) according to the criteria suggested by Crawford. CONCLUSION: Open reduction and K-wire fixation of the displaced bony mallet fractures is considered as an acceptable surgical method in providing successful bony union and maintenance of joint motion.

Intrathoracic Migration of K-wire after Fixation of Proximal Huemrus Fracture: Case Report

We report an unusual case of Kirschner wire migration from the proximal humerus into the thoracic cavity and diaphragm which induced pneumothorax and hemoperitoneum. An 81-year-old woman admitted to the emergency room due to sudden onset of dyspnea. X-rays showed pneumothorax and old proximal humerus fracture fixed with rush pins and K-wires. One of K-wires was seen on the diaphragm level at posterior gutter of chest wall. Through the abdomen, K-wire was removed from the diaphragm and a chest tube was inserted. The potential for K-wires to migrate must be recognized, and frequent postoperative radiographic studies have to be performed for the early detection of loosening and migration. It appears that if K-wires are used for fixation of proximal humerus, the lateral ends must be bent to prevent medial migration, and when the desired therapeutic goals have been achieved, these pins have to be susbsequently removed as soon as possible.

Arthroscopic Treatment of Displaced tibial Intercondylar Eminence Fractures: A Comparison of K-wires vs. Screw Fixation / 대한정형외과학회잡지

OBJECTIVES: To assess and compare the degree of reduction and clinical results following arthroscopic cannulated screw and K-wire fixation for type III displaced tibial intercondylar eminence fractures. METHODS: From 1991 to 1997, 20 patients with type III of intercondylar eminence fractures were arthroscopically treated (K-wire in 12 and screw in 8) and followed up 31 mo. in average. Degrees of reduction, extension loss and residual joint laxity were checked. And statistical analysis was done (Mann Whitney U-test) . Functional results were recorded by Meyers & McKeever's criteria. RESULTS: Degrees of reduction showed +2.1mm in K-wire group, and -1.3mm in screw group (avg., p<0.05) . Anterior displacements were 2.2mm and 1.7mm in stress x-rays and 3.5mm and 1.2mm in KT-1000 arthrometer, respectively (avg.,p<0.05) . Average loss of extension was 7 in K-wire group and 3 in screw group. There were excellent 9, good 3 in K-wire group and excellent 7, good 1 in screw group. CONCLUSION: Because of arthroscopic screw fixation able to compress and sink the fragment, it may showed less extension loss and residual laxity than K-wire fixtion. It is recommendable for the first choice to the treatment of type III tibial intercondylar eminence fractures with relatively large fragment.

Treatment of the Totally Displaced Supracondylar Fracture of the Humerus in Children by Three Crossed K-Wires Fixation / 대한정형외과학회잡지

Forty children underwent three crossed K-wires fixation after reduction of the totally displaced supracondylar fracture(type IE ) of the humerus from October 1994 to March 1997, were reviewed. The patients age ranged from 3 years and 2 months to 12 years and 7 months, averaging 6 years and 6 months. Preoperatively, five patients(12.5%) had concomitant nerve injury. Three patients(7.5%) revealed ischemic sign on distal part of the fracture. All the fractures were treated within 24 hours after arrival at the emergency room. After general anesthesia, all but one fractures reduced by closed means. Each reduced fracture was fixed by two parallel K-wires in lateral side followed by one crossed medial K-wire under fluoroscopic control. The preoperative distal ischemia of the three patient restored blood supply within 24 hours after reduction. The K-wires were removed after averaging 3.3 weeks after operation in out patient clinic. Five patients revealed neurologic deficit preoperatively recovered completely within 4 months after reduction of the fractures. The followup period ranged from 12 months to 32 months, averaging 17 months. By Flynns functional and cosmetic criteria, 39 patients(97.5%) among forty patients resulted in satisfactory criteria. The one unsatisfactory patient revealed cubitus varus treated by corrective osteotomy. In conclusion, three crossed K-wires fixation is considered as effective and safe method for the totally displaced supracondylar fracture of the humerus in children.

Migration of Kirschner-wires from the Acromioclavicular joint into the Neck: Report of 2 cases / 대한정형외과학회잡지

Kirschner-wires and pins are used for the intenal fixation of the acromioclavicular joint. Many surgeons are aware of the tendency of these appliances to migrate, however, few reports of this complication have appeared in literature. This report concerns two instances of migration K-wires from the acromioclavicular joint into the neck, The potential for K-wires to migrate must be recogniged, and more frequent postoperative radiographic studies performed after the insertion of such pins to permit earlier detection of bony resorption and migration. Thereby permitting earlier removal. In cases of young adult, the wires must be removed as soon as the desired theurapeutic results have been obtained.