Closed-reduction Intramedullary Screw in Fractures of the Proximal Phalanges of the Digits of the Hand: A Series of Three Cases.

The most frequent skeletal injuries are hand fractures, which constitute around 20% of all fractures. Fractures of the phalanx are usual, comprising 6% of all fractures. Proximal phalanx fractures arise more often. The main goals of the care are to repair the anatomy, reduce the damage to soft tissue, and mobilize the damaged fingers as soon as stabilization of the fracture allows it. The present report is intended to examine the clinical and radiation effects of proximal phalanx fractures in patients treated with intramedullary screw fixation who underwent closed reduction. We report three consecutive cases of proximal phalanx fracture: two basal fractures and one simple shaft fracture. They were treated surgically with closed reduction with intramedullary headless compression screws. The preoperative magnitude of the angulation of the proximal phalanx averaged 30.3° (range: 13° to 42°). Two patients presented rotational deformity. The clinical findings were measured using the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire, and the range of motion and functional results were assessed. Complications were observed over a span of at least 3 months. The patients displayed complete active flexion-extension proximal interphalangeal joint and flexion-extension metacarpophalangeal joint without rotative deformity. The scores on the QuickDASH were satisfactory (mean: 2.3; range: 0 to 4.5). No secondary surgeries were performed, and complications were not observed. Intramedullary fixation of proximal phalanx fractures with cannulated tension screws has been shown to be a safe operation, resulting in outstanding functional performance and an early recovery. The fracture is minimized and properly consolidated by the patients.

Mirror Foot: Surgical Approach for Esthetic and Functional Improvement.

Mirror foot is a rare congenital anomaly on to the spectrum of complex foot polydactyly. It may occur in isolation or associated with other malformations or genetic syndromes. This is a subject little described in the literature, with few publications on its treatment. We herein report the case of a 4-year-old female patient who presented with a left foot with 8 fingers, without other associated deformities, whose complaints included the impossibility of wearing shoes and social stigma. Radiographically, eight metatarsi with their respective phalanges, five cuneiform bones, and absence of bone deformities in the hindfoot were verified. The surgical approach was chosen in order to promote functional and esthetic improvement, as well as a better adaptation to the use of closed shoes, according to the patient's and family's desire. A dorsal and plantar V incision was performed, with resection of three supranumerary rays, including three central metatarsi with their nine corresponding phalanges, two cuneiform bones, tendons and extra digital nerves, followed by suture of the intermetatarsal ligaments, preserving the fingers with normal appearance, decreasing the width of the foot, and maintaining proper support. The reduction was maintained through transmetatarsal fixation with Kirschner wires. The postoperative period went on with the use of a walking boot and zero load, without complications, with removal o the Kirschner wires and allowing load on the limb after twelve weeks.

Fracturas supracondíleas humerales pediátricas. Comparación de dos técnicas de reducción / Pediatric humeral supracondylar fractures. Comparison of two reduction techniquesin

Resumen Objetivo: Analizar los resultados de la técnica quirúrgica de colocación de clavillos Kirschner forma lateral versus cruzada en el manejo de las fracturas supracondíleas de húmero en pacientes pediátricos. Metodología: Se captaron a todos los pacientes con fractura supracondílea humeral en edad pediátrica que requirieron intervención quirúrgica, y posteriormente fueron evaluados a las 24 horas y 6 meses posterior al tratamiento quirúrgico para observar y comparar las diferencias entre cada técnica quirúrgica utilizada, tomando en cuenta las complicaciones agudas y tardías que se presentaron mediante un análisis con la prueba de Mann-Whitney. Resultados: Para el presente estudios se evaluaron 44 pacientes pediátricos de los cuales 70% eran hombres y 30% mujeres, en quienes se presentaron complicaciones nerviosas y angulares sin importancia significativa alguna con el sexo y edades de los pacientes, siendo la afección del nervio cubital la de mayor frecuencia con 33% en la colocación de forma cruzada. Al realizar la comparativa con discriminación de variables se obtiene que la colocación de forma lateral presenta menos complicaciones posquirúrgicas tempranas y tardías y que tales no se deben al azar. Limitaciones o implicaciones: En el presente estudio no se incluyó el tipo de daño mecánico que provoca este tipo de fractura, ni se consideró el ángulo de Baumann. Otra limitación inherente en la población pediátrica es la habilidad del explorador para detectar un déficit neurológico, especialmente en pacientes de edad temprana dado a que los reportes de una exploración física siempre son subjetivos. Además, dada la limitación en cuanto a los detalles del mecanismo específico de daño, se puede subestimar el número de daños provocados por mecanismos de alta energía. Originalidad y valor: Su importancia radica en que ambas técnicas quirúrgicas fueron realizadas por los mismos cirujanos y que se trata de un estudio en población mexicana, siendo un aporte para la literatura de este país. Conclusión: Ambas técnicas quirúrgicas presentan resultados posquirúrgicos con casos de lesión nerviosa, deformidad angular, dolor y edema persistente, pero la que los presenta en menor frecuencia es la técnica de colocación de clavillos Kirschner en forma lateral, además de causar una significancia estadística en cuanto a la disminución de presentar cubito valgo en el seguimiento tardío de los pacientes.

Abstract: Objective: To analyze the results of the surgical technique placement of Kirschner pins lateral versus crossed in the management of supracondylar fractures of the humerus in pediatric patients. Methodology: All pediatric patients with humeral supracondylar fracture who required surgical intervention and were subsequently evaluated 24 hours and 6 months after surgical treatment to observe and compare the differences between each patient. surgical technique used. Taking into account the acute and late complications that occurred, through an analysis with the Mann-Whitney test. Results: For the present studies, 44 pediatric patients were evaluated, of whom 70% were men and 30% women, in whom nerve and angular complications presented without any significant importance with the sex and age of the patients, with ulnar nerve involvement being the most frequent with 33% in cross placement. When carrying out the comparison with discrimination of variables, it is obtained that the placement laterally presents fewer early and late post-surgical complications and that such are not due to chance. Or the present study, it is considered that a placement of Kirschner pins laterally regardless of the member, age, gender or classification; leads to better post-surgical results. Limitations or implications: In the present study, the type of mechanical damage that causes this type of fracture was not included, nor was the Baumann angle considered. Another limitation inherent in the pediatric population is the ability of the examiner to detect a neurological deficit, especially in young patients since reports of a physical examination are always subjective. Furthermore, given the limited details of the specific damage mechanism, the number of damages caused by high-energy mechanisms may be underestimated. Originality or value: Its importance lies in the fact that both surgical techniques were performed by the same surgeons and that it is a study in the mexican population, being a contribution to the literature of this country. Findings or conclusions: Both surgical techniques present post-surgical results with cases of nerve injury, angular deformity, pain and persistent edema, but the one that presents them less frequently in the technique of placement of Kirschner pins laterally, in addition to causing statistical significance in terms of the decrease of presenting cubitus valgus in the late follow-up of the patients.

Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo / Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study

Introducción: La fractura de quinto metacarpiano es una dolencia muy frecuente que puede ocasionar deformidad y afectación funcional para la prensión adecuada de la mano. La reinserción a las actividades cotidianas o laborales se relaciona con el tratamiento recibido y la rehabilitación. En fracturas de cuello de quinto metacarpiano la fijación interna con aguja Kirschner es un método de tratamiento convencional con variantes que afectan su desenlace. Objetivo: Comparar los resultados funcionales y clínicos del tratamiento de las fracturas de quinto metacarpiano con el uso de agujas Kirschner vía retrógrada versus anterógrada. Material y métodos: Estudio comparativo, longitudinal, prospectivo, realizado en un hospital de tercer nivel de Traumatología, en pacientes con fractura de cuello de quinto metacarpiano, con seguimiento clínico, radiográfico y con escala Quick DASH a la tercera, sexta y octava semana postoperatoria. Resultados: Se incluyeron 60 pacientes (58 hombres, 2 mujeres), con un promedio de edad de 29,63±10,15 años, con fractura de quinto metacarpiano, tratados mediante reducción cerrada y estabilización con aguja Kirschner. La vía anterógrada mostró un rango de flexión metacarpofalángica a las 8 semanas de 89,11 grados (p<0,001; IC95% [−26.81; −11,42]), un valor de la escala DASH de 18,17 (p<0,001; IC95% [23,45; 39,12]) y un promedio de 27,35 días de incapacidad laboral (p=0,002; IC95% [16,22; 62,14]), comparada con la vía retrógrada. Conclusión: La estabilización con aguja Kirschner vía anterógrada mostró superioridad en resultados funcionales y en amplitud de movimiento metacarpofalángica comparados con los operados por vía retrógrada a la octava semana del postoperatorio.(AU)

Introduction: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the study: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methods: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. Results: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. Conclusion: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.(AU)

[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study / Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo

Introducción: La fractura de quinto metacarpiano es una dolencia muy frecuente que puede ocasionar deformidad y afectación funcional para la prensión adecuada de la mano. La reinserción a las actividades cotidianas o laborales se relaciona con el tratamiento recibido y la rehabilitación. En fracturas de cuello de quinto metacarpiano la fijación interna con aguja Kirschner es un método de tratamiento convencional con variantes que afectan su desenlace. Objetivo: Comparar los resultados funcionales y clínicos del tratamiento de las fracturas de quinto metacarpiano con el uso de agujas Kirschner vía retrógrada versus anterógrada. Material y métodos: Estudio comparativo, longitudinal, prospectivo, realizado en un hospital de tercer nivel de Traumatología, en pacientes con fractura de cuello de quinto metacarpiano, con seguimiento clínico, radiográfico y con escala Quick DASH a la tercera, sexta y octava semana postoperatoria. Resultados: Se incluyeron 60 pacientes (58 hombres, 2 mujeres), con un promedio de edad de 29,63±10,15 años, con fractura de quinto metacarpiano, tratados mediante reducción cerrada y estabilización con aguja Kirschner. La vía anterógrada mostró un rango de flexión metacarpofalángica a las 8 semanas de 89,11 grados (p<0,001; IC95% [−26.81; −11,42]), un valor de la escala DASH de 18,17 (p<0,001; IC95% [23,45; 39,12]) y un promedio de 27,35 días de incapacidad laboral (p=0,002; IC95% [16,22; 62,14]), comparada con la vía retrógrada. Conclusión: La estabilización con aguja Kirschner vía anterógrada mostró superioridad en resultados funcionales y en amplitud de movimiento metacarpofalángica comparados con los operados por vía retrógrada a la octava semana del postoperatorio.(AU)

Introduction: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the study: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methods: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. Results: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. Conclusion: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.(AU)

"/" wiring (Durukan weave) to prevent sternal cutting by wires: a propensity score matched comparison with Robicsek weave.

Introduction: Sternal closure still causes morbidity/mortality following sternotomy. Robicsek weave, cable systems, rigid plates and nitinol clips are systems employed to prevent sternal dehiscence. Aim: The aim was to document the effectiveness of a novel method using standard sternal wires decreasing load on wires and spreading load on the lateral sternum to prevent sternal cutting by wires and thus sternal dehiscence. Material and methods: 756 patients who underwent coronary revascularization with sternotomy between July 2018 and November 2022 were retrospectively analyzed. Fifty patients with "/"wiring were compared with 50 patients with Robicsek weave by propensity score matching. "/" wiring (Durukan weave) spreads load laterally on the sternum by lateral sequential knotting of wires instead of midline knotting. Outcomes were superficial and deep sternal wound infection and non-infectious sternal dehiscence. Results: There were 50 patients in each group. Mean age of the patients was 65.74 ±7.47 in Robicsek weave and 66.12 ±7.23 in Durukan weave. The perioperative characteristics of patients were comparable as propensity score matching was performed. None developed superficial sternal wound infection in Robicsek weave, whereas 2% (1) in "/"wiring. There was no deep sternal wound infection in each group. Non-infectious sternal dehiscence did not occur in either group. Conclusions: "/" wiring seems to be a safe and cost-effective method for sternal closure for preventing sternal cutting by wires, therefore preventing sternal wound related problems and dehiscence. The method is cheap, easily applicable and less time consuming than Robicsek weave, which was proven to be the safest method for sternal wire closure.

[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study.

INTRODUCTION: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde vs. antegrade Kirschner wires. MATERIAL AND METHODS: Comparative, longitudinal, prospective study at a third-level trauma centre in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilisation with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION: Stabilisation with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children.

Objective To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle. Methods An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system. Results A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases. Conclusion The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.

Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study. / Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo.

INTRODUCTION: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. MATERIAL AND METHODS: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children / Comparação entre fixação de fio de Kirschner liso e de parafusos canulados em fraturas deslocadas do côndilo lateral do úmero em crianças

Abstract Objective To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle. Methods An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system. Results A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases. Conclusion The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.

Resumo Objetivo Comparar o uso de parafusos canulados e de fios de Kirschner lisos em termos da redução da presença de calo exuberante e de complicações em fraturas pediátricas deslocadas do côndilo lateral do úmero. Métodos Um estudo analítico transversal de casos consecutivos foi realizado de maio a outubro de 2021 com 30 crianças com fraturas deslocadas de côndilo umeral externo. Os resultados funcionais para dor e amplitude de movimento foram estratificados utilizando o sistema de classificação Dhillon. Resultados Ao todo, 19 pacientes foram submetidos à fixação de fio Kirschner, e 11 à fixação de parafusos canulados. A fixação realizada foi fechada em 14 casos (47%) e aberta em 16 (53%). Dos casos incluídos, não houve perda no acompanhamento. A amostra continha 21 (70%) pacientes do sexo masculino, e a idade variou de 5 a 15 anos, com média de 6,96 anos. A causa mais frequente de fratura foi queda de altura (50%), e esteve relacionada ao maior deslocamento nas radiografias da linha de base. Complicações que não estavam relacionadas à abordagem de redução ou ao implante utilizado foram observadas em 12 (40%) casos. Conclusão Este estudo não mostra benefícios em relação ao uso de pinos lisos ou de parafusos canulados para reduzir a presença de calo exuberante na consolidação da fratura. Vemos que as complicações que surgem estão relacionadas à gravidade da lesão, e não é possível identificar benefícios na escolha de um implante ou outro. Pudemos ver que a classificação de Weiss ajuda a definir o comportamento em favor da redução aberta ou fechada sem dar preferência ao pino liso ou ao parafuso canulado para a fixação da fratura.

Use of Kirschner wire for immediate interim reconstruction of continuity defect of mandible in resource poor setting: Our experience.

Background: Reconstruction of continuity defect of mandible is challenging, and there has been a lot of advancement in this field with variety of options for restoration. However, choice often becomes restricted in resource limited settings due to lack of trained manpower, time, infrastructure, supply of graft materials, etc. In this context, we aim to test the reliability of Kirschner wire (K-wire) with adaptation of looped-end for immediate interim reconstruction of continuity defect of mandible. Methods: Retrospectively, medical records of 10 years data were reviewed to include 22 patients who underwent immediate interim reconstruction of mandible with K-wire with looped-end adaptation for continuity defect of mandible. Data regarding patient demographic, type and length of mandibular defect, diameter of the wire and complications were recorded. Result: Among 22 patients within a follow-up period of 1-60 months (median 7.5), complications developed in 7 (31.8%) patients. Three patients (13.6%) had major complications which required interventions, and 5 patients (22.3%) with minor complications were managed conservatively. Total wire removal in our study is only 9%, which is lowest among the reported literature, migration or extrusion through bone was nil, and overall aesthetic and functional result was good in majority except few where either wire had to be removed or got deformed. Conclusion: Kirschner wire (K-wire) should be considered in resource limited setting as an immediate interim reconstructive method of mandible for being cheap and widely available. Our technique of looped-end adaptation results in better stabilisation leading to less removal rate, migration or extrusion.

Principios de fijación mediante Kirschner en las fracturas supracondíleas de húmero en el niño

Introducción: Las fracturas supracondíleas de húmero en el niño son lesiones frecuentes. El tratamiento de estas lesiones por lo general es de tipo quirúrgico mediante la reducción cerrada o abierta y colocación de alambres de Kirschner. Objetivo: Actualizar y brindar información sobre la fijación con alambres de Kirschner en pacientes pediátricos con fracturas supracondíleas de húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon las siguientes palabras: pediatric supracondylar humeral fractures AND pinning, pinning configuration, pinning loosening AND pediatric supracondylar fractures. Para centrar la búsqueda se utilizaron los operadores boléanos OR o AND según correspondía. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 211 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se utilizaron 38 citas seleccionadas para realizar la revisión, todas de los últimos cinco años. Resultados: Se hace referencia a los tipos de alambre de Kirschner empleados para la fijación de este tipo de fracturas. Se mencionan las configuraciones de alambres más utilizados, como la de dos alambres laterales seguidos de la fijación cruzada. Se exponen los errores más frecuentes en la colocación de los alambres, además de las complicaciones relacionadas con este procedimiento quirúrgico. Conclusiones: Las fracturas supracondíleas del húmero en niños son en general de manejo quirúrgico. La reducción cerrada y osteosíntesis mediante la colocación de alambres de Kirschner percutáneos requiere de conocimientos técnicos específicos.

Introduction: Supracondylar humeral fractures in children are frequent injuries. The treatment of these injuries is generally a surgical one through closed or open reduction and placement of Kirschner wires. Objective: To update and provide information on Kirschner wire fixation in pediatric patients with supracondylar humeral fractures. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and the following words were used: pediatric supracondylar humeral fractures AND pinning, pinning configuration, pinning loosening AND pediatric supracondylar fractures. To focus the search, the Boolean OR or AND operators were used as appropriate. Based on the information obtained, a bibliographic review of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search reference manager EndNote. Of which 38 selected citations were used to conduct the review, all from the last five years. Results: References are made to the types of Kirschner wire used for this kind of fracture fixation. The most widely used wire configurations are mentioned, such as two lateral wires followed by crossed fixation. The most frequent errors in the placement of the wires are exposed, in addition to the complications related to this surgical procedure. Conclusions: In general, supracondylar humeral fractures in children require surgical management. The closed reduction through the placement of percutaneous Kirschner wires, require specific technical knowledge.

Reduction of comminuted fractures of the anterior wall of the frontal sinus using threaded Kirschner wires and a small eyebrow incision.

BACKGROUND: Frontal sinus fractures are relatively rare. Their surgical management significantly differs depending on whether the posterior wall is invaded and the clinical features vary. A bicoronal incision or endoscopic approach can be used. However, the minimally invasive approach has been attracting attention, leading us to introduce a simple and effective surgical method using multiple-threaded Kirschner wires. METHODS: All patients had isolated anterior wall fractures without nasofrontal duct impairment. The depth from the skin to the posterior wall was measured using computed tomography to prevent injury. The edge of the bone segment on the skin was marked, a threaded Kirschner wire was inserted into the center of the bone segment, and multiple Kirschner wires were gently reduced simultaneously. RESULTS: Surgery was performed on 11 patients. Among them, seven patients required additional support for appropriate fracture reduction. Therefore, a periosteal elevator was used as an adjunct through a small sub-brow incision because the reduction was incomplete with the Kirschner wire alone. The reduction results were confirmed using facial bone computed tomography 1 to 3 days postoperatively. The follow-up period was 3 to 12 months. CONCLUSION: The patients had no complications and were satisfied with the surgical results. Here we demonstrated an easy and successful procedure to reduce a pure anterior wall frontal sinus fracture via non-invasive threaded Kirschner wire reduction.

Migration of Broken Kirschner Wire to the Brachial Plexus after Fixation of Fracture Dislocation of the Acromioclavicular Joint.

A complication of Kirschner (K) wire fixation is the migration of the wire. We report a patient who had undergone fixation of a right clavicle fracture associated with acromioclavicular joint (ACJ) dislocation 15 years ago. He presented with features of pain and dysaesthesia in the right ulnar nerve dermatome on the movement of the neck and shoulder. Radiographic investigations showed a broken K-wire that had migrated to the lower brachial plexus. He underwent surgical removal of the K-wire and recovered uneventfully. We summarise the literature on K-wire migration reported following clavicle and ACJ injuries. Level of Evidence: Level V (Therapeutic).

Broken pin removal from hip joint using arthroscopic grasper - A technical note and review of literature.

Guidewire breakage during a surgical procedure is uncommon but still challenging for orthopedic surgeons. Due to the potential for harmful complications, surgeons prefer to remove broken wires near the joint surface or neurovascular bundle in the hip region. Due to the depth of the location, the retrieval procedure is arduous, time-consuming, and potentially dangerous. This study describes a case of a sub-capital femoral neck fracture that was fixed with a cannulated screw. However, three years later, the distal portion of the guidewire broke and migrated into the hip joint, where it became entrapped. This study describes a method for removing a broken wire from the hip region and a relevant literature review. In brief, initially, we untightened the screw and removed it. Afterward, the broken wire was reached by reaming in the direction of the screw. Ultimately, we advanced the arthroscopic grasper to the broken wire for removal under fluoroscopic guidance. The study's findings indicate that this method could provide a promising outcome with minimal complications.

Finger Amputation after Pinning of the Distal Interphalangeal Joint for Acute Closed Tendinous Mallet Finger: A Rare but Devastating Complication.

The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger. Level of Evidence: Level V (Therapeutic).

Transverse pinning of concomitant first and second metatarsal fractures using 1.5mm K-wires; case report and technical note.

Introduction and importance: Here we represented a new technique of closed reduction and transverse pinning to address first metatarsal comminuted fractures in patients with a concomitant second metatarsal shaft fracture. Case presentation: The first metatarsal comminuted fracture coincides with the second metatarsal simple fracture in this forefoot injury case. In a new technique, we used close reduction and percutaneous pinning (CRPP) in a transverse direction of pins to achieve a satisfactory outcome.After performing traditional CRPP to fix the second metatarsal fracture, it served as physical support for the first metatarsal fixation. We drilled two 1.5mm pins through the first metatarsal bone at each proximal and distal side of the fracture site, transversely passed to the second metatarsal bone. Transverse pins came along from the first metatarsal medial side to the lateral. After six-week and 12-month follow-up, the patients had minimal pain with complete radiological and clinical fracture healing and no complication. Clinical discussion: Here, internal fixation was unsuitable due to extensive soft-tissue injury and inadequate bone support. Despite the many advantages of external fixators, they have drawbacks that persuade us to perform our new technique: using K-wires for transverse pinning fixation of the first metatarsal fracture using an adjacent metatarsal as support. This minimally invasive approach is profitable because of its minimal soft tissue damage, affordable price, and convenient access. Conclusion: The transfixation technique with K-wires is rarely used to treat metatarsal fractures. It may be helpful in similar cases of comminuted first metatarsal fracture with satisfactory outcomes.

DOES ULNA FIXATION ALTER THE OUTCOME FOR DISTAL-THIRD FOREARM FRACTURES IN CHILDREN?

Introduction: Fractures of the distal third of the forearm are common in the pediatric population. Conservative treatment of an ipsilateral fracture of the distal ulna metaphysis is one of the risk factors for loss of reduction. Percutaneous fixation of the fracture with K-wires is recommended. This study aims to evaluate the outcome of percutaneous fixation of both bones performed as the primary treatment. Materials and Methods: A randomized, open, prospective, clinical trial was conducted, including skeletally immature patients who underwent surgery for fractures of the distal radius and ulna. They were randomized into two groups, one with fixation only of the radius fracture and the other with fixation of both the radius and the ulna fractures, and they were followed clinically and radiologically for up to 12 weeks postoperatively. Results: Sixteen children were selected. In the intraoperative period, fluoroscopy was activated for a longer time when fixing the ulna (p = 0.011) and the surgical time was longer in this group (p = 0.014). In the postoperative evaluations, the group whose surgery involved the fixation of both bones had a lower postoperative pain score (p <0.001) and less time away from school (p <0.001). Conclusions: In this study, postoperative pain and absence from school were both less when fixation of the radius and ulna was performed. Evidence Level II; Randomized Controlled Study.

Introdução: As fraturas do terço distal do antebraço são comuns na população pediátrica. O tratamento conservador da fratura ipsilateral da metáfise distal da ulna é um dos fatores de risco para a perda da redução. Recomenda-se a fixação percutânea da fratura com fios K. Este estudo tem como objetivo avaliar o resultado da fixação percutânea de ambos os ossos realizada como tratamento primário. Materiais e Métodos: Foi realizado um estudo clínico randomizado, aberto e prospectivo, que incluiu pacientes com esqueleto imaturo que foram submetidos à cirurgia para fraturas da parte distal do rádio e a ulna. Os participantes foram randomizados em dois grupos, um com fixação apenas da fratura do rádio e outro com fixação das fraturas do rádio e da ulna, e foram acompanhados clínica e radiologicamente por até 12 semanas de pós-operatório. Resultados: Dezesseis crianças foram selecionadas. No intraoperatório, a fluoroscopia foi ativada por mais tempo na fixação da ulna (p = 0,011) e o tempo cirúrgico foi maior nesse grupo (p = 0,014). Nas avaliações pós-operatórias, o grupo cuja cirurgia envolveu a fixação de ambos os ossos teve escore de dor menor depois da cirurgia (p < 0,001) e menos tempo de afastamento da escola (p < 0,001). Conclusões: Neste estudo, a dor pós-operatória e o afastamento da escola foram menores quando se realizou fixação do rádio e da ulna. Nível de Evidência II; Estudo randomizado controlado.

[Application of extended trochanter osteotomy wire fixation combined with autologous bone graft in revision of total hip arthroplasty].

OBJECTIVE: To investigate the clinical effect of using lengthened trochanteric osteotomy wire fixation combined with autologous bone graft in patients undergoing revision total hip arthroplasty. METHODS: From December 2010 to December 2018, 18 patients underwent revision of total hip arthroplasty with extended trochanteric osteotomy wire fixation and autogenous bone graft, including 8 males and 10 females with an average age of (78.89±3.32) years old ranging from 68 to 82 years. The time from the initial replacement to the revision was 9 to 22 (16.33±2.93) years. The patients were followed up regularly after operation. The healing time of osteotomy, the time of full weight-bearing activity, Harris score of hip joint and complications were recorded. RESULTS: All 18 patients were followed up for 16 to 38 months with an average of (25.78±6.65) months. The incision length was 16 to 21 cm with an average of (18.89±1.32) cm; the operation time was 105 to 128 min with an average of (115.44±6.59) min, the bleeding volume was 240 to 285 ml with an average of (267.44±13.77) ml. The healing time of osteotomy was 12 to 18 weeks with an average of (15.61±1.75) weeks. Harris score of hip joint was (47.11±5.04) before operation, (76.39±3.85) during full weight-bearing activities, and (82.22±2.76) at the final follow-up(P<0.05). During the follow-up period, there were no complications such as limb shortening, infection, poor incision healing, prosthesis loosening and sinking, and periprosthetic fracture. CONCLUSION: In revision total hip arthroplasty, the use of extended trochanteric osteotomy wire fixation combined with autologous bone graft can achieve satisfactory clinical results, but the surgeon needs to make a systematic plan for the pre-revision, intraoperative and postoperative recovery.

Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study.

PURPOSE: To compare functional and radiological outcomes of transverse patella fractures treated with tension band wiring using either two 4.5 mm cannulated screws or Kirshner wire. METHODS: This is a non-blinded prospective randomized study comprising of two groups (n = 30 each) with closed transverse patella fractures treated with tension band wiring using Kirschner wire (K wire group) and two 4.5 mm cannulated screws (CCS group). Outcomes measured were radiological union, Knee Society score, range of motion and post-operative complications. RESULTS: The CCS group showed a statistically significant higher range of motion than K wire group for each follow up (p < 0.001 in flexion and p < 0.005 in extension). A statistically significant higher percentage of patients in the CCS group showed signs of union at 6th and 12th post-operative week (p = 0.001 and 0.011 respectively) but no difference at 24th post-operative week (p = 0.313). The rate of hardware complications was significantly higher in K wire group (p = 0.001). No significant difference was noted in in the Knee society score and post-operative complications between the groups. CONCLUSION: This study concludes that the fixation of closed transverse patella fractures using two 4.5 mm cannulated screws is allows a faster rate of union, a better knee range of motion and lesser hardware complications as compared to Kirschner wires. However more studies with larger sample sizes and longer follow up are required.