COMPARATIVE STUDY BETWEEN FIBULA PLATING VERSUS INTRAMEDULLARY K-WIRE WITH MEDIAL MALLEOLAR SCREW IN FIXATION IN BIMALLEOLAR FRACTURES OF ANKLE

Background: Pott's fracture is eponym of bimalleolar fracture, which account for one fourth of patients of ankle injury, it is more common in women, people over 60 years of age. There has been an increase in the prevalence of one such fracture over the last two decades both in the young, active patients and in the elderly. Objectives: The aim of this study was to compare the clinical and functional results of patients with bimalleolar fractures treated with semi tubular / reconstruction plating or intra medullary k-wire in fibula along with medial malleolar screw. Material And Method: This was a prospective randomized comparative study carried out using fibula plating and intramedullary k wire for fixation of lateral malleolus fracture and malleolar screw fixation for fracture medial malleolus among 60 patients admitted in S.M.S Hospital, Jaipur during the study period of April 2018 to December 2019. Informed consent was taken and functional assessment of patient was done at 1, 3 and 6 months after discharge according to the Modified ankle score of Olerud Molander. Results: The quantitative data was presented as mean and standard deviation and were compared by student's t-test. Probability was considered to be significant if less than 0.05. There was a significant differences (P=0.008 & P=0.001) in both the groups on the basis of mean duration of partial weight bearing (weeks) and initiation of full weight bearing (weeks). There was a significant difference in both the groups on the basis OMAscore at 1, 3 and 6 months. Conclusion: The final functional outcome was compared by Modified Olerud & Molander Score. 24 (80%) cases in fibula plating group had excellent to good results whereas, 15 (50%) cases in intramedullary k wire group had excellent to good results (P=0.010). In conclusion, cases managed by Fibula Platting had better functional outcome as compared to those treated by Intramedullary K Wire group.

Comparison of Intramedullary K-Wire Nailing versus Plate for Fixation in Metacarpal Midshaft Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates. MATERIALS AND METHODS: This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically. RESULTS: Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups. CONCLUSION: Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.

Arthrodesis of Distal Interphalangeal Joints in the Hand with Interosseous Wiring and Intramedullary K-wire Fixation

BACKGROUND: To evaluate the efficacy of intramedullary K-wire fixation and interosseous wiring in the arthrodesis of the distal interphalangeal (DIP) joint with description of surgical procedure. METHODS: We retrospectively analyzed 9 cases (7 women and 2 men) of DIP joint arthrodesis. The average age of patients was 44.2 years (range, 21 to 71 years) and the mean follow-up period was 19.6 months. Joint union was evaluated on the follow-up radiographs together with postoperative complications. RESULTS: All cases achieved radiologic union of the arthrodesis site. There was no surgical complication except for one case of skin irritation by the interosseous wire knot which was removed during the follow-up period. CONCLUSIONS: Intramedullary K-wire fixation and interosseous wiring could be an alternative procedure of arthrodesis in the DIP joint.

Antegrade Intramedullary Prebent K-wire Fixation for the 5th Metacarpal Neck Fracture

PURPOSE: To evaluate radiological and clinical results of the antegrade intramedullary prebent K-wire fixation for the 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January, 2006 and December, 2009, 31 patients with displaced neck fracture of the fifth metacarpal who received antegrade intramedullary prebent K-wire fixation were included in this study. Radiological and clinical outcome evaluations were performed. RESULTS: All the fractures were completely united. In the oblique radiographs, the average of preoperative angulation was corrected from 38.9degrees to 4.4degrees. The average difference between postoperative and final follow-up was 1.2degrees. Clinical outcomes were satisfactory except for one patient who had sustained ulnar nerve dorsal branch injury during surgery. CONCLUSION: Antegrade intramedullary prebent K-wire fixation may be preferentially considered as one of the best ways to fix the displaced neck fractures of the fifth metacarpal.

Percutaneous Transphyseal Intramedullary K-wire Fixation for the Diaphyseal Forearm Fractures in Children

PURPOSE: Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children. MATERIALS AND METHODS: In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up. RESULTS: The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found. CONCLUSION: In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

Intramedullary K-wire Fixation for Displaced Fracture of Distal Radius

PURPOSE: To evaluate indications and effectiveness of intramedullary K-wire fixation for distal radial fractures. MATERIALS AND METHODS: Twenty one fractures of distal radius treated with intramedullary K-wire fixation from April 2001 to September 2002 were evaluated. The mean age was 67.8(range 46~82). Severely comminuted intra-articular fractures and Barton's fractures were excluded. One or two K-wires were added percutaneously. To assess the functional result, we used Green and O'Brien score system. The radiographic assessment included a scoring system based on measurements of radial length, radial inclination, volar tilt and step-off of the radial articular surface. RESULTS: Average follow up period was 13.5 months. In functional result, excellent and good result were obtained in 18 cases (86%). In radiologic result, mean loss of radial length, radial inclination and volar tilt were 0.9 mm, 1.4degrees, 0.9degrees, respectively. CONCLUSION: The advantages of intramedullary K-wire fixation were relatively simple procedure, low occurrence of soft tissue complications and early wrist motion. Intramedullary K-wire fixation was good to maintaining reduction in osteoporotic bone.