Evaluating Kirschner wire fixation versus titanium plating and screws for unstable phalangeal fractures: A systematic review and meta-analysis of postoperative outcomes.

Background: Unstable phalangeal fractures represent a clinical challenge in hand surgery. The choice of fixation method, whether Kirschner wire (K-wire) fixation or titanium plating with screws, often depends on surgeon preference due to the lack of comprehensive comparative data. This article aimed to compare the postoperative outcomes of K-wire fixation versus titanium plating and screws in the treatment of unstable phalangeal fractures. Methods: This review was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. A systematic review and meta-analysis of the existing literature was done encompassing PUBMED, EMBASE, Google Scholar, and Cochrane library using the keywords: "K wire/ Kirschner wire", "titanium plate/ screws", "Miniplate/ screws", and "Unstable phalan∗ fracture/ hand fracture". Results: After screening 2374 articles, 6 final studies with a total of 414 patients were included. Operative time was significantly shorter with K-wire fixation compared to plating, by a mean difference of -27.03 â€‹min [95% CI -43.80, -10.26] (p â€‹= â€‹0.02). Time to radiographic union averaged 7.43 weeks with K-wires versus 8.21 weeks with titanium plates. No statistically significant differences emerged between groups for overall complications (p â€‹= â€‹0.69), infection (p â€‹= â€‹0.47), malunion (p â€‹= â€‹0.36), stiffness (p â€‹= â€‹0.11), or need for reoperation (p â€‹= â€‹0.10). Conclusion: K-wire fixation demonstrated shorter mean operating time and faster radiographic union versus plating for unstable phalangeal fractures. These findings can guide surgical decisions and emphasize the need for individualized treatment based on fracture type and patient factors.

Comparison of elastic stable intramedullary nailing versus Kirschner wires in treatment of pediatric radial neck fractures.

Purpose: The aim of the study was to compare the different internal fixations between elastic stable intramedullary nailing and Kirschner wires in treatment of angulated radial neck fractures. Methods: We retrospectively reviewed the patients with radial neck fracture without associated injuries who underwent surgery approach in our department during April 2011-March 2020. There were 62 patients meeting all the criteria with complete clinical data, with median age of 7.5 (IQR 5.8-9.5) years, 34 males and 28 females. The preoperative fracture pattern was assessed according to the Judet classification system. Depending on the materials implanted and fixation strategy, the patients could be divided into a Kirschner wire group and an elastic stable intramedullary nailing group. Final functional outcomes of patients were assessed by the Mayo Elbow Performance Score and Tibone-Stoltz functional evaluation classification. Results: The Kirschner wire group included 37 patients, with 4.8 years median follow-up. The elastic stable intramedullary nailing group included 25 patients with 5.9 years median follow-up. There were no significant differences in gender, age, Judet classification, average operative time, Mayo Elbow Performance Score, Tibone-Stoltz classification, or length of hospital stay between groups. However, the time to union in the Kirschner wire group was significantly shorter than that in the elastic stable intramedullary nailing group (p < 0.05). Both groups achieved satisfactory functional and cosmetic results. Conclusion: In the management of pediatric radial neck fractures, both elastic stable intramedullary nailing and Kirschner wire internal fixation have shown equivalent therapeutic results, leading to satisfactory functional outcomes. The selection of the internal fixation approach can be influenced by the patient's fracture characteristics and the surgeon's preferences. Level of evidence: Level III; Retrospective Comparison; Treatment Study.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods.

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study.

Objective: The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. Methods: This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. Results: The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. Conclusion: The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.

Kirschner Wire Prying and Leverage Technique: a new closed reduction method in treatment of pediatric "Irreducible Supracondylar Humerus Fractures".

BACKGROUND: This study employs an innovative closed reduction approach to treat pediatric "Irreducible Supracondylar Humerus Fractures" with the goal of demonstrating its practical application compared to conventional methods. METHODS: This study sampled 146 surgically treated cases of "Irreducible Supracondylar Humerus Fractures" in our department. After applying inclusion and exclusion criteria, 120 children were selected and divided into two groups based on treatment methods. Group 1 underwent Closed Reduction and Percutaneous Pinning (CRPP), while Group 2 received treatment using the Kirschner Wire Prying and Leverage Technique alongside CRPP. The relevant data to the study were collected and assessed during the follow-up period. RESULTS: Results indicate that Group 2 demonstrated significantly shorter operative times and fewer instances of intraoperative fluoroscopy compared to Group 1. Furthermore, the percentage of cases requiring open reduction was notably higher in Group 1 than in Group 2. The analysis also identified age, BMI, time from injury to surgery, and the initial deviation of the distal fragment as independent risk factors associated with the failure of closed reduction. The integration of CRPP with the Kirschner Wire Prying and Leverage Technique emerges as a safe and effective strategy for managing "Irreducible Supracondylar Humerus Fractures." This innovative approach not only reduces operative time and intraoperative fluoroscopy needs but also diminishes the reliance on open reduction without compromising safety.

Management of Open Supracondylar Humeral Fracture in Children: A Case Report and Literature Review.

Open supracondylar humeral fractures (SHFs) are rare, and there have been few papers specifically addressing their management. In this report, we describe the management and 27-month outcomes of an open SHF. A healthy eight-year-old boy presented with open SHF of the right elbow and underwent percutaneous lateral fixation using two Kirschner wires (K-wire) after irrigation and debridement (I&D) through an anterior approach. Excellent outcomes were obtained without any complications over a 27-month follow-up period. The management of open SHFs in children is yet to be standardized; nevertheless, we believe that I&D is a crucial step, that well-done lateral entry K-wires could provide the required stability, that the anterior approach is logical, safe, and effective, and that the high healing potential of children is our ally in such injuries.

Rare Reconstruction of Four Metatarsals Using Kirschner Wires After a Severe Crushing Injury: Surgical Decision Making and Prognosis.

Metatarsal fractures are one of the most common injuries after foot trauma. It is debilitating, as the metatarsals are one of the most crucial bones for any weight-bearing movement. This report demonstrates the beneficial outcome of using Kirschner wires (K-wires) in a trauma setting and the complicated healing process. A 56-year-old gentleman was brought into the emergency department after a reinforced cement pipe fell onto the patient's steel-toe boots, striking his left foot immediately proximal to the steel portion of the boot. The patient had sustained displaced comminuted fractures of the left second, third, fourth, and fifth metatarsals with an extensive open wound (Gustilo type II open fracture). Open reduction with internal fixation (ORIF) was performed using K-wires to restore and preserve the anatomical and functional integrity of the foot. Following the surgery, the patient developed a hammer toe of the left fifth metatarsophalangeal (MTP) joint two months after the ORIF; we performed resection arthroplasty to relieve discomfort and further aid the recovery process. Following the resection arthroplasty, eschar had formed at the surgical site, extending from the lateral aspect of the left foot to the plantar surface, for which we had performed a skin graft after excisional debridement of the necrotic tissue. After one year of close follow-ups with rigorous physical therapy exercises, the patient had a fair recovery process and is now able to ambulate without any assistive devices. As such, using K-wires remains a viable option for reducing misaligned metatarsal fractures and providing fairly good outcomes even in the setting of severe foot trauma.

METACARPAL FRACTURES TREATMENT: COMPARASION BETWEEN KIRSCHNER WIRE AND INTRAMEDULLARY SCREW.

Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

A Rare Volar Carpo-metacarpal Joint Dislocation in a Child: A Case Report and Literature Review.

Introduction: Carpometacarpal joint (CMCJ) dislocations are a rare presentation and a volar dislocation in a pediatric patient even more so. We present a case of this condition along with management strategies to help guide future treatment of this injury. Case Report: A fit and well 8-year-old boy presented with pain and deformity of his right hand following a fall from a horse. He had no history of previous trauma or injury to this hand. X-rays demonstrated a volar dislocation of the second CMCJ, along with several metacarpal base fractures. This injury was managed emergently with closed reduction in the Emergency Department and then underwent definitive treatment through percutaneous Kirschner wire (K-wire) fixation 2 days after injury. At 3- month follow-up, the patient and his family reported no pain, and on examination, there was no deformity and he had excellent range of motion. The patient had already returned to horse riding with no issues. Conclusion: A volar carpometacarpal dislocation in a pediatric patient is an uncommon presentation. We were able to achieve a full functional recovery using a mixture of closed reduction and K-wire fixation techniques. This clinical experience offers several learning points and also guidance around management strategies for future presentations of this condition.

Bilateral clavicle fracture: A case report.

Clavicle fractures are among the most common fractures in adults. Nevertheless, bilateral fractures are rarely reported in the literature. We present the case of a 35-year-old male patient who was admitted with a bilateral clavicle fracture following a motorcycle accident. The patient underwent open reduction and bilateral intramedullary fixation with Kirschner wires. After six months of follow-up, the functional result was satisfactory; the patient achieved full range of motion in both shoulders and was free from pain. X-rays showed a complete fusion of the fracture on both sides.

Finite Element Analysis of the Mechanical Strength of Phalangeal Osteosynthesis Using Kirschner Wires.

Background: Kirschner wire (K-wire) fixation is widely used to repair metacarpal and phalangeal fractures. In this study, we simulated K-wire osteosynthesis of a 3-dimensional (3D) phalangeal fracture model and investigated the fixation strength at various K-wire diameters and insertion angles to clarify the optimal K-wire fixation method for phalangeal fractures. Methods: The 3D phalangeal fracture models were created by using computed tomographic (CT) images of the proximal phalanx of the middle finger in five young healthy volunteers and five elderly osteoporotic patients. Two elongated cylinders representing K-wires were inserted according to various cross-pinning methods; the wire diameters were 1.0, 1.2, 1.5 and 1.8 mm, and the wire insertion angles (i.e. the angle between the fracture line and the K-wire) were 30°, 45° and 60°. The mechanical strength of the K-wire fixed fracture model was investigated by using finite element analysis (FEA). Results: The fixation strength increased with increasing wire diameter and insertion angle. Insertion of 1.8-mm wires at 60° achieved the strongest fixation force in this series. Fixation strength was generally stronger in the younger group than the elderly group. Dispersion of stress to cortical bone was a critical factor to increase fixation strength. Conclusions: We developed a 3D phalangeal fracture model into which we inserted K-wires; using FEA, we clarified the optimal crossed K-wire fixation method for phalangeal fractures. Level of Evidence: Level V (Therapeutic).

Fractura-luxación glenohumeral posterior tratada con fijación transitoria con agujas de Kirschner: reporte de un caso / Posterior glenohumeral fracture-dislocation, transitory operative treatment with kirschner wire-fixation: case report

Las luxofracturas glenohumerales posteriores, son un conjunto de lesiones poco frecuentes, que pueden llegar a ser subdiagnósticadas debido a no tener una clínica tan específica como las luxaciones glenohumerales anteriores; las luxofracturas posteriores pueden ser mucho más complejas dependiendo de que lesiones asociadas puedan presentar. Se presenta un caso de un paciente quien ameritó reducción y osteosíntesis en primera etapa, y por presentar un nuevo episodio de luxación, fue reintervenido con fijación transitoria con agujas de Kirschner, se describen características clínicas y radiográficas del paciente y la resolución del caso. (AU)

Posterior glenohumeral fracture-dislocations are a set of infrequent injuries, which can be underdiagnosed due to not having a clinic as specific as anterior glenohumeral dislocations; posterior fracture-dislocations can be much more complex depending on the associated injuries they may present. A case of a patient who required reduction and osteosynthesis in the first stage is presented, and due to presenting a new episode of dislocation, he was reoperated with transitory fixation with Kirschner wires, clinical and radiographic characteristics of the patient and the resolution of the case are described. (AU)

Fractura-luxación glenohumeral posterior tratada con fijación transitoria con agujas de Kirschner: reporte de un caso / Posterior glenohumeral fracture-dislocation, transitory operative treatment with kirschner wire-fixation: case report

Las luxofracturas glenohumerales posteriores, son un conjunto de lesiones poco frecuentes, que pueden llegar a ser subdiagnósticadas debido a no tener una clínica tan específica como las luxaciones glenohumerales anteriores; las luxofracturas posteriores pueden ser mucho más complejas dependiendo de que lesiones asociadas puedan presentar. Se presenta un caso de un paciente quien ameritó reducción y osteosíntesis en primera etapa, y por presentar un nuevo episodio de luxación, fue reintervenido con fijación transitoria con agujas de Kirschner, se describen características clínicas y radiográficas del paciente y la resolución del caso. (AU)

Posterior glenohumeral fracture-dislocations are a set of infrequent injuries, which can be underdiagnosed due to not having a clinic as specific as anterior glenohumeral dislocations; posterior fracture-dislocations can be much more complex depending on the associated injuries they may present. A case of a patient who required reduction and osteosynthesis in the first stage is presented, and due to presenting a new episode of dislocation, he was reoperated with transitory fixation with Kirschner wires, clinical and radiographic characteristics of the patient and the resolution of the case are described. (AU)

The Novel Hooked Kirschner Wire Technique for Ulna Coronoid Process Fractures.

Background: The aim of this study was to introduce a novel technique to improve the ease of fixing of even small fragments of the coronoid process and report the clinical outcomes of this method. Methods: Forty-nine patients with ulnar coronoid process fractures fixed using the hooked Kirschner wire (K-wire) technique at our hospital from 2007 to 2019 were reviewed. Radiological features and fracture union were assessed using simple radiographs. Functional outcomes of the treated elbows were evaluated at the final follow-up visit using the Mayo Elbow Performance Score (MEPS). Results: All patients were examined at a mean follow-up of 17.7 months (range, 6-62 months). We observed bony union in patients at a mean of 10.9 weeks (range, 6-22 weeks). The mean flexion and extension ranges of the elbow were 132.0° (range, 106° -151°) and 4.5° (range, -20° to 30°), respectively. The mean pronation and supination ranges of the forearm were 81.1° (range, 60°-90°) and 88.3° (range, 60°-120°), respectively. The mean arc of the elbow was 127.4° (range, 78°-160°). All patients were evaluated using the MEPS at the final follow-up visit, with a mean score of 96.9 points (range, 80-100 points). One case of coronoid nonunion was observed and re-fixation was performed. One case of infection was observed and also treated with additional surgery. Three patients complained of ulnar nerve symptoms and 1 patient underwent surgical release for tardy ulnar nerve palsy. Conclusions: Despite its limitations, the hooked K-wire technique was a useful method for even smaller coronoid process fractures. K-wires were also a useful temporary intraoperative fixation method and could provide permanent fixation.

Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study.

BACKGROUND: Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS: This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS: In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION: Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE: Level III: Retrospective comparative study.

Comparing Calcaneus Fracture Radiographic Outcomes and Complications after Percutaneous Pin versus Screw Fixation.

Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. Percutaneous fixation with Kirshner wires (K-wires) or screws may be implemented when soft tissue injury precludes an open approach. Although screws are thought to provide greater stability, limited data exists directly comparing fixation success of these implants. Medical record data from 53 patients (62 total fractures) surgically treated with percutaneous screws (28 fractures) or K-wires (34 fractures) for joint-depression calcaneus fractures at a large tertiary hospital were retrospectively reviewed. Bohler's angle and calcaneal varus were assessed from available radiographs at time of injury, postoperatively, and at final follow-up, and joint congruity was assessed postoperatively and at final follow-up. Complications were also extracted. There were no statistical differences in patient characteristics between surgical groups although a higher proportion of patients treated with K-wires compared to screws had other associated injuries (79% vs 42%, p = .01). A higher proportion of fractures treated with screws compared to K-wires maintained joint congruity at the final follow-up (69% vs 32%, p = .005). However, there were no statistically detectable differences in other postoperative radiographic metrics (p > .05). In conclusion, joint congruity was more often maintained with screw fixation although there was no statistical difference in restoration and maintenance of Bohler's angle or varus alignment. The difference in radiographic metrics was not correlated with secondary procedures, namely subtalar arthrodesis, and may not be clinically significant. Neither group was completely effective in attaining and maintaining reduction, and additional fixation strategies should be considered if feasible based on patient, injury, and soft tissue characteristics.

Metacarpal fractures treatment: comparasion between kirschner wire and intramedullary screw / Tratamento de fraturas metacarpais: comparação entre fios de kirschner e fixação intramedular

ABSTRACT Introduction: Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Objectives: Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. Results: The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. Conclusion: The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

RESUMO Introdução: Fraturas dos metacarpos são frequentes e podem ser tratadas de forma cirúrgica com os fios de Kirschner (FK) e Fixação Intramedular com Parafuso de Compressão (FIPC). Objetivo: Analisar os resultados pós-operatórios do tratamento das fraturas extra-articulares dos metacarpos pela técnica retrógrada com fios de Kirschner e comparar com a fixação intramedular utilizando parafuso de compressão. Métodos: Estudo retrospectivo, quantitativo, com análise de prontuários, utilizando questionários de avaliação pós-operatória em dez pacientes divididos em dois grupos: FIPC e FK. Resultados: O período de imobilização com tala nos grupos FK e FIPC foram de seis e quatro semanas respectivamente, já o tempo médio para consolidação foi de 57 e 47 dias respectivamente. O grupo FK retornou as atividades laborais após os FIPC. O valor médio de força na mão acometida comparada a contralateral foi de 93,9% no grupo FK, e no FIPC de 95,4%. Medidas da soma de amplitude de movimento das articulações metacarpofalangeanas e interfalangeanas no grupo FK obtiveram diferença média entre as mãos operada e a contralateral de 16°, já na FIPC observou-se 5°. Conclusão: Os pacientes estudados apresentaram excelentes resultados pós-operatórios e ambos os tratamentos provam ser seguros e confiáveis. Nível de evidência III; Estudo retrospectivo comparativo .

Treatment for transverse patella fractures with minimally invasive techniques (Review).

The transverse fracture pattern is the most common pattern among patellar fractures. Although open reduction with internal fixation using tension band wiring is the common method for treating the majority of transverse patellar fractures with displacement, this approach has distinct disadvantages, including damage to the blood supply and general post-operative complications. Therefore, minimally invasive techniques have been introduced to overcome these problems. In the present review, the advanced surgical procedures using Kirschner wires with cerclage, cannulated screw optioning of supplementary cerclage tension banding, external fixation and combined tension-band braided polyester with a suture button, as well as post-operative rehabilitation, were described in detail. To improve any malreduction due to poor control of the patellar articular surfaces, the utility of arthroscopically assisted techniques was also presented. The advantages and disadvantages of the above-mentioned techniques were also discussed. Minimally invasive techniques were demonstrated to achieve improved knee joint mobility, shorter hospitalization and more favorable outcomes. Such techniques decrease the risk of complications compared to conventional open reduction and fixation. Although specific problems associated with each technique still require to be resolved to reduce late complications, such as the onset of patella-femoral arthritis, minimally invasive techniques remain an alternative option for treating transverse patellar fractures.

The curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers and its influencing factors / 中国医师进修杂志

Objective:To explore the curative effect of modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers, and analyze the related influencing factors of curative effect.Methods:The clinical data of 100 patients with skeletal mallet fingers from January 2018 to December 2020 in Yanzhou Branch of Affiliated Hospital of Jining Medical University were retrospectively analyzed, and the patients were treated with modified double Kirschner wire compression fixation. Before surgery and 8 weeks after surgery, the Fugl-Meyer score, simple test for evaluating hand function (STEF) score and visual analogue score (VAS) were assessed, and the flexion range of knuckles was measured. The curative effect was evaluated by Crawford standard, excellent and good means was good prognosis, medium and poor was poor prognosis. Binary Logistic regression was used to analyze the influencing factors of curative effect in patients with skeletal mallet fingers, Spearman method was used to analyze correlation.Results:All incisions healed in the first stage 14 d after surgery, the function and structure of the hand recovered well, and related incision skin necrosis and needle tract infection did not occur. Compared with before surgery, the Fugl-Meyer score, STEF score and flexion range of knuckles 8 weeks after surgery were significantly higher: (62.58 ± 4.56) scores vs. (32.33 ± 2.84) scores, (91.31 ± 3.19) scores vs. (62.51 ± 3.42) scores and (66.72 ± 3.65)° vs. (45.56 ± 2.31)°, the VAS was significantly lower: (2.65 ± 1.19) scores vs. (5.68 ± 1.43) scores, and there were statistical differences ( P<0.01). According to Crawford standard, good prognosis was in 79 cases, and poor prognosis was in 21 cases. There were no statistical differences in gender composition, injury location, cause of injury and type of injury between good prognosis patients and poor prognosis patients ( P>0.05); compared with the poor prognosis patients, the good prognosis patients were younger, the time from injury to surgery was shorter, the injured parts were mainly the little finger and ring finger, and there were statistical differences ( P<0.05 or <0.01). Binary Logistic regression analysis result showed that age, time from injury to operation and injury site were independent risk factors of curative effect in patients with skeletal mallet fingers ( OR = 4.62, 5.94 and 2.33; 95% CI 1.06 to 20.14, 2.23 to 15.81 and 1.12 to 4.82; P<0.05 or <0.01). Spearman correlation analysis result showed that the curative effect was positively correlated with age, time from injury to operation and injury location ( r = 0.25, 0.62 and 0.43; P<0.05 or <0.01). Conclusions:Modified double Kirschner wire compression fixation in the treatment of skeletal mallet fingers can promote the recovery of finger function after surgery, but age, damaged location and time of visit are independent risk factors of curative effect.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children.

OBJECTIVE: Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow. The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children. METHODS: From February 2015 to August 2019, 73 patients with Gartland's type II and III supracondylar fractures were treated with this modified method. Totally, 68 of all patients were followed up for 3-12 months (mean 8.25 months). The evaluation results included fracture nonunion, ulnar nerve injury, pin track infection, carrying angle and elbow joint Flynn score. RESULTS: The results showed that bone union was observed in all children, one case had an iatrogenic ulnar nerve injury, and the symptoms were completely relieved in 4 months after removing of the medial-side pin. All children had no cubitus varus deformity and no pin track infection, and the rate of satisfactory results according to Flynn's criteria score was 100%. CONCLUSION: The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction, the risk of iatrogenic ulnar nerve injury, and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.