Should we bury K-wires after metacarpal and phalangeal fracture osteosynthesis?

BACKGROUND: Burying Kirschner wires (K-wires) under the skin after metacarpal and phalangeal fracture osteosynthesis may reduce risk of infection, but it might also complicate later removal. PURPOSE/AIM OF STUDY: To examine infection and reoperation rates after metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. MATERIALS AND METHODS: Metacarpal and phalangeal fractures treated with K-wire osteosynthesis at our institution from 1st of January, 2009 to 1st of February, 2015 were identified retrospectively. The final study population included 444 patients, 331 with metacarpal, 109 phalangeal and 4 with mixed fractures. Surgical and patient records were examined 90 days postoperatively. FINDINGS/RESULTS: 337 patients (75.9%) were treated with buried K-wires and 107 patients (24.1%) with exposed (non-buried) K-wires. 14 patients (4.1%) treated with buried K-wires presented with postoperative infection, opposed to 7 patients (6,5%) treated with non-buried K-wires (p = 0.311). None of the postoperative infections caused re-operation. Only one case of deep/severe infection was recorded in a patient treated with buried K-wires requiring intravenous antibiotic treatment. In 58 of 337 patients (17.2%) treated with buried K-wires, removal was not possible in the outpatient clinic and required readmission for removal in the operation theatre. All exposed K-wires could be removed in the out-patient clinic without re-operation. CONCLUSIONS: We found no difference in postoperative infection rate between metacarpal and phalangeal fracture osteosynthesis with buried versus exposed K-wires. However, the high readmission and reoperation rate (17.2%) after burying K-wires should call for reconsideration of surgical strategies.

Implementing, adapting, and validating an evidence-based algorithm for hip fracture surgery.

OBJECTIVES: Reoperations are common after surgical treatment of hip fractures but may be reduced by optimal choice of implant based on fracture classification. We hypothesized that implementing a surgical treatment algorithm was possible in our hospital and would result in a reduced reoperation rate. DESIGN: Retrospective comparative study. SETTING: Provincial level III trauma center. PATIENTS: The evidence-based "Hvidovre Algorithm" for treatment of hip fractures was adopted and implemented at our provincial institution in September 2008. Three hundred eighty-six consecutive patients older than 50 years admitted with a hip fracture in the first year after implementation were prospectively included and compared with 417 retrospectively included similar patients admitted within the last year before implementation. INTERVENTION: Implementation of an evidence-based treatment algorithm for hip fracture surgery. RESULTS: Eighty-five percent (330 of 386) patients were operated according to the algorithm after implementation, compared with 67% (280 of 417) of procedures before implementation (P < 0.001). After implementation, the overall reoperation rate showed a tendency toward a reduction to 8% (32 of 386) from 12% (48 of 417) (P = 0.1). Among all the 803 included patients, the reoperation rate was lower if procedures had been performed according to the algorithm recommendations: 9% (53 of 610) versus 14% (27 of 193) (P = 0.009). CONCLUSIONS: The algorithm for hip fracture surgery was easily implemented, and our results support that using it facilitates a low reoperation rate. The reoperation rate may be further reduced with higher adherence to algorithm recommendation. LEVEL OF EVIDENCE: Therapeutic level III. See instructions for authors for a complete description of levels of evidence.

Outcome of an uncemented hydroxyapatite coated hemiarthroplasty for displaced femoral neck fractures: a clinical and radiographic 2-year follow-up study.

BACKGROUND AND PURPOSE: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures (DFNF) in elderly patients. The use of uncemented stems remains controversial and issues regarding inferior fixation in osteoporotic bone, implant-related pain and decreased mobility have discouraged their use. There is limited evidence for the use of modern uncemented femoral stems in the treatment of DFNF, and we wished to investigate the clinical and radiographic performance of an uncemented hydroxyapatite coated hemiarthroplasty at 2-year follow-up. PATIENTS AND METHODS: We included 97 consecutive patients who had an uncemented, hydroxyapatite coated hemiarthroplasty (Corail, Depuy) inserted during a 1-year period. Due to unwillingness or cognitive impairment (n = 6) and death before follow-up (n = 44), a total of 47 patients (39 females) with a mean age of 81 years were available. RESULTS: At two year follow-up 38 of 47 patients lived in their own homes and the median New Mobility Score was 6 (range: 2-9). The median Visual Analogue Scale pain score was 0 (range: 0-5) at rest and 0 (range: 0-8) when walking. Patient satisfaction was a score of 9 (range: 2-10) on the VAS. Anterior or lateral thigh pain or groin pain was reported by 15 patients. The EQ-5D index score at follow-up was 0.72 (range: 0.16-1.00) and the EQ-5D Visual Analogue Score was 70 (range: 15-100). There were no signs of implant loosening in any of the 37 hips undergoing radiographic evaluation at follow-up. CONCLUSION: The results suggest that an uncemented hydroxyapatite coated hemiarthroplasty can be used to treat displaced intracupsular femoral neck fractures with good clinical and radiographic outcomes at short term follow-up.

Assessment of hip dysplasia and osteoarthritis: variability of different methods.

BACKGROUND: Reliable assessment of hip dysplasia and osteoarthritis is crucial in young adults who may benefit from joint-preserving surgery. PURPOSE: To investigate the variability of different methods for diagnostic assessment of hip dysplasia and osteoarthritis. MATERIAL AND METHODS: By each of four observers, two assessments were done by vision and two by angle construction. For both methods, the intra- and interobserver variability of center-edge and acetabular index angle assessment were analyzed. The observers' ability to diagnose hip dysplasia and osteoarthritis were assessed. All measures were compared to those made on computed tomography scan. RESULTS: Intra- and interobserver variability of angle assessment was less when angles were drawn compared with assessment by vision, and the observers' ability to diagnose hip dysplasia improved when angles were drawn. Assessment of osteoarthritis in general showed poor agreement with findings on computed tomography scan. CONCLUSION: We recommend that angles always should be drawn for assessment of hip dysplasia on pelvic radiographs. Given the inherent variability of diagnostic assessment of hip dysplasia, a computed tomography scan could be considered in patients with relevant hip symptoms and a center-edge angle between 20 degrees and 30 degrees . Osteoarthritis should be assessed by measuring the joint space width or by classifying the Tönnis grade as either 0-1 or 2-3.

[Abdominal penetrating trauma]. / Abdominalt penetrerende traume.

A 19-year-old female was brought to the Emergency Room as a trauma patient. During a tilting contest she fell off the horse and was penetrated by a spear used for tilting the ring. She was respiratorically as well as haemodynamically stable. The spear was supported but not removed by the paramedics. The spear penetrated the patient near the left iliac crest pointing at the heart. Further investigation at the Emergency Room is described briefly and guidelines for penetrating, impaled foreign bodies in the (thoraco)abdominal region are outlined.