Fracturas supracondíleas en pacientes pediátricos tratados quirúrgicamente con Técnica de Cruzada. Hospital Central San Cristóbal / Supracondylar humerus fractures in childrens surgically treated by Crossed Wiring Technique. San Cristóbal Central Hospital

Las fracturas supracondíleas en niños se asocian con algunas complicaciones. Su tratamiento estándar es la reducción cerrada y la fijación con alambres en distintas configuraciones. Se realizó un estudio observacional, analítico, prospectivo y longitudinal con pacientes pediátricos que ingresaron con fracturas supracondíleas de húmero tratados quirúrgicamente con alambres de Kirschner con "Técnica Cruzada" en el Hospital Central San Cristóbal enero a junio de 2022. Se incluyeron 30 pacientes. La edad promedio fue 6,3±2,2(3-10) años. La causa más frecuente del traumatismo fue la precipitación de altura en 63,3% de los casos. La posición del codo al momento del accidente fue en extensión en 90%. Todas las fracturas fueron cerradas. El tiempo promedio desde el accidente hasta su atención en emergencia fue de 8,5±13,4(2-72) horas. Los signos clínicos más frecuentes fueron dolor en 100,0%, limitación funcional en 96,7%, aumento de volumen 73,3% y deformidad 50,0%. Según la clasificación AO la más frecuente fue del tipo 13-M/3. 1 III en el 50% de los casos y según Gartland, las tipo IIIA en 53,3%. A las 4 semanas, 100,0% de las fracturas consolidaron, 13,3% presentó valgo y 6,7% varo en la radiografía anteroposterior. Mientras que, en la lateral, 33,3% antecurvatum. La media del ángulo de Baumann fue de 20,27±1,39 grados. La tasa de complicaciones fue de 16,66%, 2(6,7%) casos presentaron neuropraxia y 3(10,0%) granuloma. En conclusión, la Técnica Cruzada es segura en términos de reducción, funcionalidad y tasas de complicaciones en el seguimiento a medio plazo(AU)

Supracondylar fractures in children are associated with some complications. Its standard treatment is closed reduction and fixation with wires in different configurations. An observational, analytical, prospective and longitudinal study was made, with pediatric patients admitted with supracondylar humeral fractures surgically treated with Kirschner wires with the "Cross Technique" at the Hospital Central San Cristóbal from January to June 2022. 30 patients were included. The mean age was 6,3±2,2(3-10) years. The most frequent cause of trauma was high altitude precipitation in 63,3% of the cases. The position of the elbow at the time of the accident was 90% extended. All fractures were closed. The mean time from the accident to emergency care was 8,5±13,4(2-72) hours. The most frequent clinical signs were pain in 100,0%, functional limitation in 96.7%, volume increase in 73,3%, and deformity in 50,0%. According to the AO classification, the most frequent was type 13-M/3. 1 III in 50% of cases and according to Gartland, type IIIA in 53,3%. At 4 weeks, 100,0% of the patients consolidated, 13,3% presented valgus and 6,7% varus on the anteroposterior radiograph. While, on the side, 33,3% antecurvatum. The mean Baumann angle was 20,27 ± 1.39 degrees. The rate of complications was 16,66%, 2 (6,7%) cases presented neuropraxia and 3 (10,0%) granuloma. In conclusion, the Crossover Technique is safe in terms of reduction, functionality, and complication rates in medium-term follow-up(AU)

Method of closing fasciotomies by progressive tissue traction / Método de fechamento de fasciotomias por tração tecidual progressiva

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.

O trauma de grande energia vem aumentando de maneira expressiva na última década, em boa parte de membros inferiores, necessitando, em muitos casos, de fasciotomia devido à síndrome compartimental subsequente. Neste contexto muitas vezes seu fechamento acaba por levar a um retardo no tratamento integral do paciente, do retorno a suas atividades e podendo levar a infecção local, além de gerar altos custos. Há muitas opções ao cirurgião plástico para a tentativa de aproximação de bordos e reconstrução das extremidades, como retalhos, enxertos, curativo a vácuo e sutura elástica, além de dispositivos de expansão, sendo, às vezes, com combinação das anteriores. O método de fechamento apresentado através do alongamento progressivo da pele com fio de Kirschnner representa uma forma de baixo custo e facilmente reproduzível para lidar com este tipo de ferida.

Clinical effect of arthroscopic reduction and suture for tibial intercondylar eminence fractures by perforated Kirschner wire / 中华实用儿科临床杂志

Objective:To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-" 8" suture.Methods:From January 2018 to December 2020, 24 children (14 males and 10 females, aged 6-15 years) with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction, non-absorbable Krackow-" 8" suture for the base of the anterior cruciate ligament, and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks, followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results:All the 24 cases were successfully operated, with the operation time of (63.1±20.2) (40-115) min.All children were followed up for 24-36 months[(28.7±3.4) months]. All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement, suture rupture, or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up, the Lysholm score and IKDC 2000 subjective score were (94.4±4.8) points and (93.8±5.6) points, respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions:Arthroscopic reduction with non-absorbable Krackow-" 8" suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures, minimal invasiveness, which is an effective treatment method.

Clinical effect of Kirschner wire intramedullary fixation in the treatment of pediatric both-bone forearm fractures at high altitude area / 中国骨伤

OBJECTIVE@#To explore the clinical effect of Kirschner wire intramedullary fixation in the treatment of both-bone forearm fractures in children of high altitude area.@*METHODS@#From August 2020 to December 2021, 19 children were treated with Kirschner wire intramedullary fixation including 11 males and 8 females, aged from 4 to 13 years old with an average of (8.16±2.71) years old. The course of disease was 1 to 10 days, with a mean of (4.11±2.51) d. First, close reduction was performed. If the reduction was unsuccessful, limited open reduction was performed, followed by Kirschner wire intramedullary fixation of the radius and ulna. The fracture healing was evaluated by X-ray after operation, and the curative effect was evaluated by Anderson forearm function score standard.@*RESULTS@#The wound healed well after operation, 2 cases had clinical manifestations of needle tail irritation after operation, and the symptoms disappeared after removing the internal fixation. The average follow-up time was(7.68±3.50) months (3 to 14 months). X-ray showed that all fracture healing in follow-up, Anderson forearm function score showed excellent in 16 cases, good in 2 cases and fair in 1 case at the final follow-up.@*CONCLUSION@#Children with fractures in plateau areas often have delayed medical treatment, lack of medical conditions and insufficient compliance. Based on these characteristics, Kirschner wire intramedullary fixation for the treatment of children's double forearm fractures has the advantages of small injury and rapid recovery. It is a kind of operation method that can be popularized.

Comparison of the efficacy of three types of Kirschner wire tension bands for ulnar olecranal fracture / 中国骨伤

OBJECTIVE@#To compare the clinical effect of three types of Kirschner wire tension band for olecranon fracture.@*METHODS@#The clinical data of 64 patients with olecranon fracture treated by Kirschner wire tension band fixation from March 2016 to May 2020 were retrospectively analyzed. Among them, 19 patients were treated with intramedullary K-wires fixation(group A) including 8 males and 11 females with an average of (48.2±18.3) years old, 3 patients were typeⅠ, and 16 patients were typeⅡ according to Mayo classification;20 patients were treated with transcortical K-wires fixation (group B) including 13 males and 7 females with an average of (43.5±20.4) years old, 3 patients were typeⅠand 17 patients were typeⅡ according to Mayo classification;25 patients were treated with perforated Kirschner wire(group C) including 15 males and 10 females with an average of (55.2±17.5) years old, 4 patients were typeⅠand 21 patients were typeⅡ according to Mayo classification. The operative time, intraoperative blood loss, times of Intraoperative fluoroscopy, fracture healing time and complications of 3 groups were compared. At the final follow-up, elbow function was assessed using the Mayo Elbow Function Scale.@*RESULTS@#There were differences in operative time, intraoperative fluoroscopy times, postoperative VAS and soft tissue irritation among the three groups(P<0.05). The operative time, intraoperative fluoroscopy times in group A and C was better than that in group B. The postoperative VAS score, skin irritability in group C was better than that of group B. The difference was statistically significant on Mayo elbow function score at the final follow-up among three groups(P<0.05), the scores of group A and C were higher than that of group B.@*CONCLUSION@#Compared with transcortical K-wires screw fixation, both intramedullary K-wires screw fixation and perforated Kirschner wire fixation, which can significantly reduce the occurrence of soft tissue irritation, reduce surgical complications and shorten the operation time.

Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Effectiveness on treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the effectiveness of Kirschner wire buckling combined with bone fixation in the treatment of metacarpal avulsion fracture.@*METHODS@#The clinical data of 35 patients of metacarpal avulsion fracture admitted between March 2017 and June 2022 were retrospectively analyzed. There were 22 males and 13 females; the age ranged from 20 to 55 years, with an average of 31.6 years. There were 17 cases of the second metacarpal avulsion fracture, 6 cases of the fourth metacarpal avulsion fracture, and 12 cases of the fifth metacarpal avulsion fracture. The causes of injury included 21 cases of strangulation, 8 cases of sprain, and 6 cases of sports injury. X-ray film examination showed that the size of the avulsion fracture of metacarpal bone ranged from 0.30 cm×0.20 cm to 0.55 cm×0.45 cm. The total active motion (TAM) of the injured finger before operation was (154.00±17.38)°. The time from injury to operation was 3-10 days, with an average of 5.8 days. Follow-up regularly after operation, X-ray film and CT examination were performed to evaluate fracture healing and TAM of injured finger was measured. The finger function was evaluated by the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association.@*RESULTS@#All the incisions healed by first intention. All 35 patients were followed up 9-36 months, with an average of 28 months. All metacarpal avulsion fractures achieved bony healing, and the healing time was 4-6 weeks, with an average of 4.8 weeks. The metacarpophalangeal joint of the patient was stable, without stiffness, and the flexion and extension activities were good. At last follow-up, the TAM of the injured finger reached (261.88±6.23)°, which was significantly different from that before operation ( t=-35.351, P<0.001). The finger function was evaluated according to the trial standard of upper limb function evaluation of the Society of Hand Surgery of Chinese Medical Association, and 33 cases were excellent and 2 cases were good, with an excellent and good rate of 100%.@*CONCLUSION@#The treatment of metacarpal avulsion fracture with Kirschner wire buckling combined with bone fixation has the advantages of less trauma, firm fixation, and less interference to the soft tissue around metacarpophalangeal joints, which is a good alternative method for the metacarpal avulsion fracture.

Arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation.@*METHODS@#The clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation.@*RESULTS@#All patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation ( t=12.851, P<0.001; t=-14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair.@*CONCLUSION@#Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.

Effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in treatment of Cho type ⅡC distal clavicle fractures / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures.@*METHODS@#The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up.@*RESULTS@#All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5).@*CONCLUSION@#Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.

Cannulated screws with sutures for treatment of transverse patellar fractures / 中华创伤骨科杂志

Objective:To evaluate the clinical efficacy of cannulated screws with sutures in the treatment of patellar transverse fractures.Methods:A retrospective analysis was performed of the data of 70 patients with patellar transverse fracture who had been admitted to Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital from January 2017 to March 2021. According to the construction methods for the tension band, the patients were divided into 3 groups. In group A of 21 cases subjected to fixation with cannulated screws with sutures (Fiber-Tape), there were 8 males and 13 females with a median age of 55.0 (48.0, 65.0) years; in group B of 32 cases subjected to fixation with Kirschner wire tension band, there were 15 males and 17 females with a median age of 52.5 (41.5, 63.0) years; in group C of 17 cases subjected to fixation with Cable-Pin system, there were 5 males and 12 females with a median age of 55.0 (37.0, 65.0) years. The 3 groups were compared in terms of complications, secondary surgery (removal of internal fixation), operation time, intraoperative blood loss and knee function rated by the Lysholm and B?stman scores at the last follow-up.Results:There were no significant differences in the preoperative general data between the 3 groups, showing they were comparable ( P > 0.05). There was no significant difference in the operation time, intraoperative blood transfusion or follow-up time among the 3 groups ( P > 0.05). The incidence of soft tissue irritation [4.8% (1/21)] and the secondary operation rate [4.8% (1/21)] in group A were significantly lower than those in group B [43.8% (14/32) and 37.5% (12/32)] and group C [41.2% (7/17) and 35.3% (6/17)] ( P < 0.05), but there was no statistically significant difference between group B and group C ( P > 0.05). In groups A, B and C, respectively, the Lysholm knee score was 84.0 (69.0, 88.0), 89.0 (71.5, 95.0) and 82.0 (63.0, 90.0), and the B?stman knee score 26.0 (23.0, 28.0), 26.5 (24.0, 27.5) and 26.0 (22.0, 28.0), showing no significant difference ( P > 0.05). There was no significant difference either in the incidence of other complications among the 3 groups ( P > 0.05). Conclusion:In the treatment of patellar transverse fractures, compared with the Kirschner wire tension band and Cable-Pin system, cannulated screws with sutures (Fiber-Tape) may lead to a lower incidence of soft tissue irritation and a lower rate of secondary surgery, but no significant differences in operation time, intraoperative blood loss, other complications or postoperative functional scores.

Mechanical Properties of Novel Interlocking Intramedullary Nail for Fixing Transverse Olecranon Fractures / 医用生物力学

Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.

Clinical application of a Kirschner wire assisted double-hook water-injection hernia needle in complicated pediatric oblique inguinal hernia / 中华实用儿科临床杂志

Objective:To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods:The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results:Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88) years vs.(4.91±2.39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm 3vs.9 650.97(3 849.24, 17 539.51) mm 3]. The differences in the age at surgery and hernia sac volume were statistically significant ( t=-5.407, Z=-4.218; all P<0.001). There was no significant difference in body mass index between the 2 groups ( P>0.05). Taking hernias with sac volume >10 000 mm 3 as huge hernias, there were 70.18%(40/57 cases) and 47.25%(146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15, 20) min vs.15(15, 20) min] ( Z=-2.842, P<0.05). However, the operation time for huge oblique hernias with sac volume >10 000 mm 3 was not statistically significant between the 2 groups ( P>0.05). No recurrence in both groups was found during 6-16 months of follow-up. Conclusions:For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas de-ferens and spermatic cord vessels smoothly.As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar.With good feasibility and safety, it is applicable for clinical popularization.

Auxiliary positioning of a new positioning device in internal fixation of femoral neck fracture with cannulated screws / 中国组织工程研究

BACKGROUND: At present, the application of intelligent positioning devices such as orthopedic robots and computer navigation systems in closed reduction surgery for femoral neck fractures is gradually developed, and grassroots hospitals still need a cheap auxiliary positioning device. OBJECTIVE: To investigate the effect of a Kirschner wire positioning device for assisted localization in internal fixation of femoral neck fracture with cannulated screws. METHODS: Fifty-four cases of femoral neck fracture treated in Binzhou Medical University Hospital from February 2016 to March 2018 were retrospectively analyzed. The patients were allocated into the two groups, 28 patients who received traditional cannulated screws internal fixation were in the traditional group, and 26 patients who received assisted localization internal fixation with cannulated screws were in the assisted localization group. The angle, direction and distance of the Kirschner wire could be quantified and fine-tuned, assisted with accurate positioning, and the placement of the cannulated screws was guided. Clinical and imaging data were compared between two groups. RESULTS AND CONCLUSION: (1) All patients received surgery successfully. No intraoperative complications such as vascular or nerve injury occurred. Postoperative image showed good fracture reduction, cannulated screw distribution, angle and position. (2) The operation time in the assisted localization group (49.27±4.86) minutes was shorter than that in the traditional group (59.64±8.02) minutes (P 0.05). The excellent and good rate of Harris score in the assisted localization group was 89%. (4) No necrosis of femoral head occurred during the follow-up, and the rate of late necrosis should be followed up. (5) Our findings suggest that Kirschner wire positioning device can assist in quantitative positioning and guide the placement of cannulated screw in the internal fixation of femoral neck fracture. It can effectively improve the positioning efficiency, reduce the number of fluoroscopy, avoid repeatedly adjusting the penetration to damage femoral neck bone, and promote the recovery of patients.

The Effect of Intra-carpal Kirschner Wire Augmentation in Screw Fixation of Scaphoid – A Retrospective Cohort Study

@#Introduction: Scaphoid fractures are most often treated with a single headless compression screw. However, intercarpal Kirschner wire (K-wire) might be added to improve stability and fracture outcomes. This study will determine if there is a difference in treatment outcome (union rate and time to union) between scaphoid fracture fixations using a single headless compression screw with and without augmentation using a intracarpal intramedullary K-wire. Material and Methods: We conducted a retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15 years period from December 2000 to December 2015. Only patients who underwent open surgery with bone grafting were included. They were divided into a group treated with a single screw fixation, and another group treated with screw and K-wire fixations. Results: Forty-four (58.7%) patients had single screw fixation and 31 (41.3%) had screw augmented with K-wire fixation. The overall union rate was 88.0%, with an overall mean time to union of 5.3 months. There was no difference in union rate (p=0.84) and time to union (p=0.66) between the single screw group and combined screw and K-wire group. Univariate analysis found that older age (t=-2.11, p=0.04) had a significant effect on union rate. Regression model showed that age had a significant effect on months to union. Conclusion: In open fixation of scaphoid fractures with compression screw and bone grafting, union rate and time to union is comparable whether or not screw fixation was augmented with an intracarpal K-wire. There was no increased risk of complications associated with augmented screw. Age of patient affected time to union and union rate.

Feasibility study of Kirschner wire-fixation-cortical bone technique in treatment of intertrochanteric fracture / 中国修复重建外科杂志

Objective: To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods: Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results: In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group ( P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group ( Z=-2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation ( t=2.98, P=0.01). Conclusion: The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.

Arthroscopic minimally invasive Kirschner wire tension band internal fixation combined with lower limb feedback training in the treatment of patellar fractures / 中国综合临床

Objective To investigate the clinical effect of arthroscopy minimally invasive Kirschner wire tension band internal fixation combined with lower limb feedback training for patellar fracture.Methods Fifty-eight cases of patellar fracture who received arthroscopy minimally invasive Kirschner tension band internal fixation from March 2016 to April 2018 in Linxi Hospital,Kailuan General Hospital were included in this study.All cases were divided into control group (32 cases) and observation group (26 cases) according to the different rehabilitation methods.Control group received routine rehabilitation,observation group received intelligent feedback system of the lower limbs based on the control group.The recovery of joint function was compared between two groups.Results The clinical efficacy of the observation group was excellent (18 cases),good (6 Cases),and medium (2 cases),the excellent and good rate was 92.30％ (24/ 26).In the control group,the clinical effect was excellent (19 cases),good (9 cases),and medium (4 cases).The excellent and good rate was 87.50％ (28/32).There was no significant difference in clinical efficacy (z =0.80,P＞ 0.05) and excellent and good rate (x2 =0.36,P＞ 0.05) between two groups after 6 months follow-ups.The scores and total scores of B(o)stman patellar fracture function before treatment in observation group were pain (3.3 ± 0.8),Knee range of motion (3.2 ± 0.7),work (1.8 ± 0.3),muscular atrophy (1.8±0.2),auxiliaries (2.9 ± 0.6),effusion (1.2 ± 0.4),giving way (0.3 ± 0.2),climb stairs (0.3 ±0.2) andtotal score (15.0 ±2.2) respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in observation group were pain (5.7 ± 0.4),Knee range of motion (5.8 ± 0.2),work (3.6 ±0.5),muscular atrophy (3.5 ± 0.6),auxiliaries (3.7 ± 0.4),effusion (1.8 ± 0.3),giving way (1.7 ±0.4),climb stairs (1.7 ± 0.5) and total score (28.3 ± 1.6) respectively.The B(o)stman patellar fracture functional score in observation group increased significantly (t =14.62,19.15,16.47,14.78,6.96,7.18,17.26,14.16,26.30,P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture function before treatment in control group werepain (3.4 ± 0.6),Knee range of motion (3.1 ± 0.6),work (1.9 ± 0.4),muscular atrophy(1.7 ±0.3),auxiliaries (2.8 ±0.5),effusion(1.1 ±0.3),giving way(0.4±0.2),climb stairs (0.4 ±0.2) andtotal score (14.8 ±2.3),respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in control group were pain(5.2±0.6),Knee range of motion(4.9 ±0.7),work(3.1 ±0.6),muscular atrophy (2.5 ± 0.5),auxiliaries (3.2 ± 0.4),effusion (1.3 ± 0.4),giving way (1.3±0.3),climb stairs (1.2 ± 0.4) and total score (22.7 ± 2.5),respectively.The functional scores of B(o)stman patellar fracture in control group were significantly increased (t =13.26,12.44,10.16,8.17,3.38,3.22,15.14,11.31,14.13,all P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture in observation group after treatment were significantly higher than those in control group (t =3.64,6.34,3.39,6.93,4.73,5.28,4.35,4.23,9.89,P ＜ 0.05).In observation group,the range of knee joint activity at different time were before operation (30.2 ± 6.1) °,2 weeks after operation (85.6 ± 6.8) °,4 weeks after operation (100.6± 7.5) °,6 weeks after operation (118.5 ± 8.3) °,8 weeks after operation (138.9 ± 8.2) °,respectively.In control group,the range of knee joint activity at different time werebefore operation (29.3 ±7.2) °,2 weeks after operation (74.8 ± 6.9) °,4 weeks after operation (92.8 ± 7.8) °,6 weeks after operation(102.8 ± 9.4) °,8 weeks after operation (121.1 ± 7.3) °,respectively.The range of knee joint activity of two groups were significantly increased with the duration of treatment,Fgroup =124.58,P ＜0.05.The increases of range of knee joint activity in observation group was significantly higher than that in control group,Fintersecrion =11.78,P＜0.05.The overall levels of range of knee joint activity in observation group were significantly higher than that of control group,and Fbetween =36.27,P＜ 0.05.The KSS scores of in observation group werebefore operation (40.5 ± 8.8),2 weeks after operation (66.4 ± 9.0),4 weeks after operation(76.8±9.1),6 weeks after operation (83.4 ±9.5) and 8 weeks after operation (89.4 ± 8.1),respectively.The KSS scores in control group at different time were before operation(38.9 ±9.2),2 weeks after operation (60.1 ± 8.3),4 weeks after operation (70.4± 8.2),6 weeks after operation (77.6± 7.3) and 8 weeks after operation(82.5±8.6) respectively.The KSS score of two groups were significantly increased with the duration of treatment,Fgroup =84.32,P＜0.05.The increases of KSS score in observation group were significantly higher than that in control group,Fintersecrion =8.94,P＜0.05.The overall levels of range of KSS score in observation group were significantly higher than that of control group,and Fbetween =28.52,P ＜0.05.Conclusion The application of lower limb feedback training system after arthroscopic minimally invasive Kirschner wire tension band fixation can promote the recovery of knee joint function in patients with patellar fracture.

Arthroscopic minimally invasive Kirschner wire tension band internal fixation in the treatment of patellar fractures / 中国综合临床

Objective To investigate the clinical effect of minimally invasive Kirschner wire tension band internal fixation under arthroscopy in the treatment of patellar fracture.Methods From March 2016 to April 2018,ninety patients with patellar fracture admitted to the Department of Orthopedics,Lin Xi Hospital of Kailuan General Hospital were divided into minimally invasive group (58 cases) and control group (32 cases) according to different operative methods.The control group received traditional open reduction and Kirschner wire tension band internal fixation.Minimally invasive group received arthroscopic minimally invasive Kirschner wire tension band internal fixation.The operation status,joint function recovery and VAS scores were compared between the two groups.Results The amount of blood loss,hospitalization time and fracture healing time in minimally invasive group were significantly less than those in control group ((48.7 ±13.6) mlvs.(85.5±12.3) ml,t=12.7,P＜0.05;(12.5±2.8) d vs.(14.8±1.4) d,t=4.35,P＜0.05;(11.2± 1.3) weeks vs.(15.4± 2.2) weeks,t =11.40,P＜0.05).After 6 months of follow-up,the VAS score of the two groups decreased with the time (the VAS score of the minimally invasive group decreased from (7.2±1.1) points preoperatively to (0.9±0.2) points at 6 months postoperatively,and that of the control group decreased from (7.3±1.2) points preoperatively to (1.1±0.3) at 6 months postoperatively).There was a significant difference between the two groups (F group =77.87,P＜0.05).The VAS score of both groups decreased with time (Ft ime=263.47,P＜0.05).The decrease of VAS score in the minimally invasive group was significantly larger than that in the control group (F interaction =28.63,P＜0.05).Conclusion Arthroscopic minimally invasive Kirschner wire tension band internal fixation for patellar fracture has better clinical effect and less trauma.

Effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture / 中国修复重建外科杂志

Objective: To summarize the effectiveness of mini locking plate combined with Kirschner wire in treatment of comminuted Jones fracture. Methods: Between January 2011 and October 2016, 25 cases with comminuted Jones fracture were treated with mini locking plate combined with Kirschner wire. There were 9 males and 16 females with an average age of 31.4 years (range, 16-66 years). The fractures located on the left side in 11 cases and on the right side in 14 cases. The causes of injury included spraining in 21 cases, falling down in 3 cases, and bruise in 1 case. The bone fragment of all cases was more than 3 pieces. The fracture line was mostly Y-shape or T-shape. Twelve of them were combined with other fractures. The time from injury to operation was 1-9 days (mean, 5 days). The mini locking plate and Kirschner wire were removed at 9-12 months postoperatively. At 12 months postoperatively, the pain was evaluated by the visual analogue scale (VAS) score, and the function by the American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All incisions healed by first intention. All cases were followed up 12-36 months with an average of 21.7 months. Fracture union was observed in all patients without complications such as nonunion, delayed union, and malunion. The fracture union time was 8-12 weeks (mean, 9.4 weeks). At 12 months postoperatively, the VAS score was 1.15±0.87; the AOFAS score was 89.45±6.24, and the results were excellent in 14 cases, good in 9 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 92%. Conclusion: The procedure of mini locking plate combined with Kirschner wire for comminuted Jones fracture has such advantages as convenient operation, more rigid fixation, high rate of fracture healing, and good functional recovery in foot.

K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures / 中华创伤骨科杂志

Objective To evaluate K-wire leverage reduction and fixation via the triceps tendon for irreducible supracondylar humeral fractures of Gartland types Ⅱ& Ⅲ. Methods From June 2014 to March 2016, 31 children with irreducible supracondylar humeral fracture were treated operatively in our hospital. They were 23 boys and 8 girls, aged from 4 to 11 years ( average, 6. 3 years ) , involving 19 left and 12 right arms. Their clinical manifestations included elbow swelling at the affected arm, obvious tenderness, and limited movement of the elbow. The reduction was conducted under the guidance of C-arm roentgenography by inserting a piece of 3. 0 mm K-wire into the fracture ends via the posterior triceps tendon, inserting 2 pieces of 1. 5 or 2. 0 mm K-wire from the distal lateral humerus to the proximal through the opposite cortical bone, and inserting a piece of 1. 5 or 2. 0 mm K-wire into the opposite cortical bone through the ulnar aspect of the distal humerus. Results The operation time for the 31 patients ranged from 28 to 42 minutes ( 33 minutes on average ) . They were followed up for 6 to 18 months ( 12. 3 months on average ) . All fractures united after 4 to 6 weeks ( 4. 6 weeks on average ) . At the final follow-ups, the lengths of the affected and healthy arms were re-spectively 66. 4 ± 2. 7 cm and 66. 4 ± 2. 9 cm, showing no significant difference ( P> 0. 05 ) . The therapeutic outcomes by the Flynn criteria for the elbow function were rated at the final follow-up as excellent in 26 cases, as good in 4 and as fair in one, yielding an excellent to good rate of 96. 8％. Pin tract infection occurred in 2 patients, but no deep infection or osteomyelitis was observed during follow-ups. Conclusion K-wire leverage reduction and fixation via the triceps is an effective and simple treatment for irreducible supracondylar humeral fractures of Gartland types Ⅱ& Ⅲ.

Clinical observation of adjustable external fixator combined with limited internal fixation for type C distal radius fractures / 临床外科杂志

Objective To investigate the clinical efficacy of adjustable external fixaor combined with limited internal fixation for type C distal radius fractures. Methods A total of 22 patients with type C distal radius fractures were treated with adjustable external fixator combined with limited internal fixation from October 2013 to January 2016. Accoiding to AO/ASIF classification, there were 6 cases defined as Cl, 7 cases as 02 and 9 cases as C3. All cases were followed up completely. The clinical efficacy was evaluated based on the wrist join function and X-ray materials. Results They were followed up from 6 month to 18 month(mean 11 months). It showed that all the fractures were healed within 3 months according to X-ray examination. According to Garland-werley evaluation standard, 15 cases were excellent, 5 cases were good and 2 cases were fair. The excellent and good rate was 90. 91％. Condusion For type C distal radius fractures, the method of adjustable external fìxaor combined with limited internal fixation can recover and maintain radius height, volar tilt angle and ulnar inclination angle effectively. It can provide satisfactory wrist join function.