A simple modification of the conventional figure-of-eight sternal closure technique

Abstract Objective: To describe a new technique of sternal closure, modified from the conventional figure-of-eight approach, which can provide a secure closure and prevent sternal complications. Methods: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016. Results: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires. Conclusion: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience.

Lesões abdominais por uso do fio guia em ensaios cirúrgicos do quadril: estudo em cadáver / Abdominal injuries due to the use of guide wire in hip surgery experiments: cadaveric study

OBJETIVO: Avaliar a relação entre lesões abdominais e a introdução de fios guia em ensaios cirúrgicos do quadril, propor um sistema de escorização e conduta médica em função da distância percorrida pelo fio guia a partir da placa quadrilátera e a estrutura anatômica lesionada. MATERIAL E MÉTODOS: Utilizou-se 18 quadris de cadáveres, um fio de Steimann de 3.2 x 300 mm, um perfurador elétrico e um paquímetro. Introduziu-se o fio no centro do colo femoral por via de acesso lateral no quadril sob visualização direta. Por via de acesso abdominal mediana longitudinal estendida à região pélvica, observou-se a placa quadrilátera até o fio a transfixar. A partir deste ponto, prolongou-se a inserção por mais 140 mm, a fim de observar seu trajeto abdominal e descrever as lesões apresentadas em função da distância percorrida. RESULTADOS: Houve cinco (27 por cento) lesões de cólon sigmóide e uma (5 por cento) lesão transfixante do nervo obturador. Artérias e veias ilíacas comuns contra laterais ao quadril fixado não foram lesionadas. CONCLUSÃO: O fio guia não deve ultrapassar a placa quadrilátera. Medidas de prevenção são importantes no pré e intra-operatório e o escore e a conduta médica propostos neste estudo devem ser criteriosamente observados nos casos de lesão comprovada.

OBJECTIVES: Evaluate the relationship between abdominal injuries and the introduction of guide wire in experimental hip surgery, to propose a scoring system and a medical management based on the distance traveled by the guide wire from the quadrilateral plate until the damaged anatomical structure. MATERIAL AND METHODS: 18 cadaveric hips, a Steimann pin of 3.2 x 300mm, an electric drill and a caliper were used. The wire was inserted in the center of the femoral neck through a lateral approach in the hip under direct visualization. Via median abdominal extended approach to the pelvic region, the quadrilateral plate was observed until the wire crossed it. From this point the wire was further inserted 140 mm in order to observe its abdominal path and describe the lesions presented based on the distance traveled. RESULTS: There were five lesions (27 percent) in the sigmoid colon, and one transfixing injury (5 percent) of the obturator nerve. The common iliac arteries and veins from the contralateral hip were not injured. CONCLUSION: The guide wire must not exceed the quadrilateral plate. Preventive measures are important in the pre- and intra-operatory stages and the score and medical management proposed in this study should be carefully observed in cases of injury.

Remplazo total de mandíbula con alambre Kirschner / Total jaw replacement with Kirschner wire

El hueso mandibular, por su disposición anatómica en la región facial, aporta considerables requisitos estéticos, por lo que cualquier evento que altere su morfofisiología repercute en la apariencia personal y en funciones elementales del ser humano. Se presenta el caso clínico de una paciente en quien una osteólisis masiva mandibular no permitió la conservación de este y mediante la reconstrucción simultánea con alambre tipo Kirschner, se posibilitó un resultado estético y funcional aceptables(AU)

The mandibular bone due to its anatomical disposition in the facial region presents considerable aesthetic requirements, since any event altering its morphophysiology influences on the personal appearance and on elementary functions of the human being. The clinical case of a patient in whom a massive mandibular osteolysis did not allow its preservation is presented. An acceptable aesthetic and functional result was possible by the simultaneous reconstruction with Kirschner wire(AU)

Unusual K-wire migration.

The authors report a case of intra-abdominal migration of a Kirschner wire from the left hip to the right lobe of the liver in a 5-year-old child. The wire was used for stabilization of the left hip after open reduction for neglected unreduced congenital dislocation of the left hip. The migrated wire was removed by laparotomy. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. This unusual migration of a Kirschner wire into a child's liver has not been reported previously.

Iatrogenic ulnar neuropathies post-pinning of displaced supracondylar humerus fractures in children

A retrospective review of 141 displaced supracondylar fractures in children at the Bustamante Children's Hospital and the University Hospital of the West Indies from 1994 to 1999 revealed ten ulnar nerve palsies. Of the 141 supracondylar fractures, 27 were treated with open reduction and internal fixation, while 114 had closed reduction and percutaneous pinning. All fractures were fixed with crossed Kirschner wires. Of the ten cases, the ulnar nerve was explored in two cases; the medial pin was removed in two cases, while the other six cases were observed. Follow-up ranged from three to 18 months. Full nerve recovery occurred in all cases except one in which there was partial return of function. Recommendations are made regarding the management of these injuries.

Fijación del tórax batiente con alambres de kirschner: quince años de experiencia / Fixation of a flail thorax using Kirschner wires: fifteen years of experience

Con el objetivo de conocer las principales características epidemiológicas, clínicas y de evaluar un nuevo método de tratamiento, se estudió una serie consecutiva de 54 pacientes ingresados en el Hospital Militar Central "Dr. Carlos J. Finlay" entre enero de 1984 y diciembre de 1998 con el diagnóstico de tórax batiente, a los cuales se les aplicó la estabilización de la pared costal con alambres de Kirschner. El tórax batiente se produjo con más frecuencia en el sexo masculino entre la cuarta y la quinta décadas de la vida, provocado fundamentalmente por accidentes del tránsito. Se evidenció una alta asociación entre tórax batiente y otras lesiones torácicas y extratorácicas que influyeron en la mortalidad. Las defunciones (25 porciento) se relacionaron fundamentalmente con traumatismos craneoencefálicos graves. En 52 pacientes se logró la estabilización de la pared costal con el uso de los alambres de Kirschner, sin aparecer complicaciones significativas con su empleo, lo que demostró sus ventajas sobre otros métodos(AU)

With the objective of finding out the main epidemiological and clinical features and of evaluating a new method of treatment, we made a study on 54 patients admitted to "Dr Carlos J. Finlay" Military Hospital from january 1984 to December 1998, who had been diagnosed with flail chest and applied the stabilization of the rib wall with Kirschmer wires. The flail chest was most frequent in males aged 40-50 years fundamentally due to traffic accidents. There was high correlation between flail chest and other thoracic and extra-thoracic injures that affected mortality. Deaths (25 percent) were mainly related with serious cranioencephalic traumas. Stabilization of rib wall using Kirschmer wires were possible in 52 patients without any significant complications. This proved the advantages of this method over the others(AU)

Tratamento pelo método de Ilizarov: análise das complicaçöes e suas repercussöes no objetivo proposto / Treatment by Ilizarov's method: analysis of the complications and their repercussion upon proposed objective

No período de julho de 1988 a novembro de 1993, 56 pacientes, totalizando 61 montagens, utilizaram o método de Ilizarov no tratamento de lesöes pós-traumáticas dos membros inferiores, sendo 44 casos na tíbia e 17 no fêmur. O aparelho foi aplicado com objetivo de estabilizaçäo (neutralizaçäo de forças) em 21 pacientes, correçäo imediata de deformidade em três, correçäo progressiva em 22, alongamento em sete e transporte ósseo em 13. Foram analisadas as complicaçöes observadas e as soluçöes utilizadas, bem como sua eficiência comparativamente. Classificamos os resultados como satisfatórios naqueles pacientes cuja evoluçäo, bem como as soluçöes propostas às complicaçöes, quando ocorreram, näo interferiram no resultado final do tratamento, na tíbia - 36 casos (81,8 porcento) e no fêmur - 14 casos (82,4 porcento) e insatisfatório naqueles em que o tratamento foi comprometido ou até mesmo fracassou, devido às complicaçöes, sendo oito casos (18,2 porcento) na tíbia e três (17,6 porcento) no fêmur

Migraçäo de um fio de Steinmann usado no tratamento de uma luxaçäo acromioclavicular: relato de caso / Migration of a Steinmann's wire following fixation of the acromio-clavicular joint: a case report

Os autores relatam caso de migraçäo intratorácica de um fio de Steinmann usado no tratamento de luxaçäo acromioclavicular. Eles enfatizam a ocorrência de tal complicaçäo quando do uso deste método e apresentam outras alternativas de tratamento.

Late ulnar nerve injury following Kirschner wires fixation of the supracondylar fracture of the humerus.

Most supracondylar fractures of the humerus can be treated by closed methods. Open reduction and internal fixation by wires or pins are indicated in a difficult fracture (Kekomaki et al 1984) or in vascular injury following the fracture. This fixation should be temporary and removed immediately upon obtaining the desired purpose. To increase surgeons awareness of inadvertently leaving the implant for too long, we are reporting an unusual complication of migration of the Kirschner wire resulting in late ulnar nerve injury.