Buried or exposed Kirschner wire for the management of hand and forearm fractures: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: The recommendation on whether to bury or expose the Kirschner wire (K-wire) for the management of fractures has still been controversial with inconsistent results in the published studies due to the potential issue associated with exposed K-wire is the heightened risk of infection, as it comes into direct contact with the external environment and air. This study aims to summarize the specific outcomes between buried and exposed K-wire for the management of hand and forearm fractures. METHODS: We conducted relevant literature searches on Europe PMC, Medline, Scopus, and Cochrane Library databases using specific keywords. This investigation focuses on individuals of any age diagnosed with hand or forearm fractures who underwent surgery involving Kirschner wire (K-wire) fixation. It examines the comparison between buried and exposed K-wire fixation, emphasizing primary outcome pin infection, along with secondary outcomes such as early pin removal, days to pin removal, and surgical duration. The study includes observational studies (cohort/case-control) or randomized clinical trials (RCTs). The results of continuous variables were pooled into the standardized mean difference (SMD), while dichotomous variables were pooled into odds ratio (OR) along with 95% confidence intervals using random-effect models. The quality of included studies was assessed with Cochrane Collaborations, Risk of Bias version 2 (RoB v2). RESULTS: A total of 11 studies were included. Our pooled analysis revealed that buried K-wire was associated with a lower risk of pin site infection [RR 0.49 (95% CI 0.36-0.67), p < 0.00001, I2 = 0%] and 33.85 days longer duration until pin removal [MD 33.85 days (95% CI 18.68-49.02), p < 0.0001, I2 = 99%] when compared with exposed K-wire. However, the duration of surgery was 9.98 minutes significantly longer in the buried K-wire [MD 6.98 minutes (95% CI 2.19-11.76), p = 0.004, I2 = 42%] with no significant difference in the early pin removal rate [RR 0.73 (95% CI 0.36-1.45), p = 0.37, I2 = 0%]. Further regression analysis revealed that sample size, age, sex, and duration of follow-up did not affect those relationships. CONCLUSION: Buried K-wire may offer benefits in reducing the infection rate with a longer duration until pin removal. However, further RCTs with larger sample sizes are still needed to confirm the results of our study.

Replantation using groin flap in thirty-four years old male with traumatic total degloving of little finger: A case report.

INTRODUCTION AND IMPORTANCE: Degloving injuries of the hand or fingers have a devastating presentation which challenges a surgeon to conduct reconstruction in order to resurface the naked finger and recover its function. The gold standard treatment for degloving injuries is using skin grafting and flap. The pedicle of groin flap is based on superficial circumflex iliac artery. It is one of standard flaps used in reconstruction of degloving fingers. In this study, we use groin flap for reconstruction of traumatic total degloving little finger. PRESENTATION OF CASE: This is a case of 34-years old man with total degloving of his left little finger because stuck inside running cutting machine in a clothes factory. The patient was then brought to the Hasan Sadikin General Hospital. The patient underwent thorough debridement, preparation of the donor site, and groin flap. After a week, the wound was in good condition with no signs of infection. CLINICAL DISCUSSION: The groin or skin flap is pedicled and vascularized by superficial circumflex artery. It can be considered as an option for treatment of single finger degloving wound because of its compliant nature and vascularization reliability. Despite this, it often results in bulky appearance which needs to be reconstructed later. THE CONCLUSION: Groin flaps are an appropriate method in managing degloving little fingers and are still cosmetically acceptable.

Novel minimally invasive management of lumbar osteomyelitis: A case report.

INTRODUCTION AND IMPORTANCE: Vertebral osteomyelitis is a rare disease that might lead to significant clinical problems. Initially, conservative therapy is considered to be sufficient for most patients. However, it is not uncommon that the infectious process may become fulminant and severe complications could arise. Recent studies have shown that percutaneous endoscopic debridement provides a favorable outcome in managing lumbar infections without severe neurological symptoms. CASE PRESENTATION: We presented a case report of a female, 49 years old, with pyogenic vertebral osteomyelitis of the 4th - 5th lumbar spine without neurologic deficit. X-ray examination showed a resemblance of the lytic lesion over the anterior aspect of the L4. We then planned a minimally invasive endoscopic procedure for the patient. We made the 1st portal to aspirate the abscess product and for the endoscopy instrument to debride the remaining debris material. We also developed the second portal using kyphoplasty needl towards the pedicle to gain access to the vertebral body. The debriding process was achieved by positive irrigation pressure from one portal to another using physiologic NaCl saline and gentamicin solution. CLINICAL DISCUSSION: Combined with the access created by the kyphoplasty needle, more thorough irrigation was made possible as the intravertebral body was approachable. Compared to open surgery, this approach can reduce surgical damage. Clinically, patient experienced an almost instant relief of pain. CONCLUSION: Percutaneous endoscopic debridement technique in addition of kyphoplasty needle allows wider area for adequate debridement and better result, while maintaining minimally invasive setting with minimum complications.

Pelvic parameter improvement following deformity correction in adolescence idiopathic scoliosis: A case series.

INTRODUCTION: Scoliosis is defined as 3-dimensional deformity of the spine with lateral deviation more than 10° and rotation of the vertebrae. Adolescence idiopathic scoliosis (AIS) is scoliosis that affect children between the age of 11-18 years old without any identifiable cause or underlying disease. PRESENTATION OF CASE: This study will compare the pelvic parameters and functional score of the patients before and after the procedure. Pelvic parameters are represented by 3 angles: pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) of 5 adolescence idiopathic scoliosis patients. Functional outcomes were evaluated using Indonesian SF-36 questionnaire and also pain scale of preoperative and postoperative. DISCUSSION: An important outcome of this study was a statistically significant improvement in coronal alignment, functional capacity, pain, and role of limitation due to physical health. Coronal angle deformity correction of AIS patients is correlated with sagittal improvement which caused by compensatory alteration of pelvic parameter. CONCLUSION: This finding correlates with the improvement of functional outcome of the patients.

Surgery on aggressive fibroma of the posterior compartment of the knee: A case report.

INTRODUCTION: Fibroma is a benign tumor. More than 99% fibroma arises from tendon sheaths or tendons. Aggressive Fibroma at posterior compartment knee is a rare case. This report presents one case of fibroma at posterior compartment of the knee with the treatment. CASE REPORT: A boy with 4-year history of knee discomfort and lump at posterior knee joint, no history of infection and trauma. Physical examination revealed a mass (10 × 9 × 7 cm) with limited Range of Motion extension 30°, flexion 70°. MRI revealed a soft tissue mass at posterior knee compartment. Histologic examination showed a circumscribed and lobulated hypo cellular mass containing spindle cells diagnosed as aggressive fibroma. The patient underwent popliteal resection. An ellipse incision was made 2 cm margin of skin around the biopsy site. Fasciocutaneous flaps were created and retracted to expose the posterior compartment. The tumor had a partial well-defined capsule, popliteal artery and vein embedded and pressing the sciatic nerve. The tumor and enveloping muscles were elevated from the base of the compartment. The sciatic nerve was preserved with epineurotomy. The popliteal artery was reconstructed with saphenous veins graft. After the tumor was resected, the heads of gastrocnemius were sutured to each other and to the hamstring muscles to cover popliteal space. After one year postoperative, there was a good vascularization, no recurrence and neurological deficit with Musculoskeletal Tumour Society Scoring System 80%. CONCLUSION: One year postoperative with popliteal resection surgery yields a good result. A follow-up is needed for risk of recurrence and malignancy.

Spinal cord injury without radiological abnormality (SCIWORA) manifested as self-limited brown-SEQUARD syndrome.

INTRODUCTION: Combination between SCIWORA and Brown-Sequard syndrome in a patient is a rare condition. In SCIWORA, there is usually a delay in neurologic deficits which can potentially lead to misdiagnosis. Therefore, the clinician should have a good understanding of the course of the disease to make a good diagnosis and treatment. CASE REPORT: Reporting a case of female 20 years old with chief complaint of severe neck pain and delayed limbs weakness. The mechanism of injury was fall with the head hit the ground in left lateral flexion position. The physical examination showed zero motor power of the right limbs and contralateral pain and temperature deficit 1 h after the injury. We diagnosed the patient with incomplete spinal cord injury at C4 level with associated Brown-Sequard syndrome. We gave soft collar neck for immobilization, medication with NSAID for analgetic and Methylprednisolon. We found dramatic improvement in 10 h after the injury with motor improvement from 0 to 5 and normal sensory function. The patient then was discharged with good functional outcome and with no sequelae. CONCLUSION: Incomplete cervical spinal cord injury without radiological abnormality that manifested as Brown-Sequard syndrome is a rare case and potentially confusing condition. Better understanding of the course of the disease may help the clinician to make a right diagnosis and plan for management.

Redesign of Indonesian-made osteosynthesis plates to enhance their mechanical behavior.

Mechanical properties determined by fatigue strength, ductility, and toughness are important measures for osteosynthesis plates in order to tolerate some load-bearing situations caused by muscle contractions and weight-bearing effects. Previous study indicated that Indonesian-made plates showed lower mechanical strength compared to the European AO standard plate. High stress under load-bearing situations often starts from surface of the plate; we therefore refined the grain size of the surface by using shot peening and surface mechanical attrition treatment (SMAT). Single cycle bending tests showed that shot-peened and SMAT-treated plates had significantly higher load limit and bending stress compared to the original plates (p<0.05). Weibull analysis confirmed the improvement of proportional load limit of SMAT-treated plates. Fatigue limit also increased upon shot-peening and SMAT treatment (improvement ratio 18% and 27%, respectively). Significant improvement ratio of fatigue tests can be observed in SMAT-treated plates compared to the untreated and shot-peened plates. Fatigue performance demonstrated equivalent results between SMAT-treated and standard plate. These designated that mechanical properties of Indonesian-made plates can be improved upon SMAT treatment leading to significant enhancement of mechanical strength thus is comparable to the standard plate. Our findings highlight the benefits of SMAT treatment to improve mechanical strength of Indonesian-made osteosynthesis plates.

Deep Vein Thrombosis in Elderly Patients following Surgery for Fracture of the Proximal Femur.

The incidence of Deep Vein Thrombosis (DVT) is high in orthopaedic cases, associated with morbidity and mortality. This study was done to evaluate the incidence of DVT and factors that contributed to DVT in elderly patients with proximal femur fracture who underwent surgery. Patients 60 years of age and older with proximal femur fracture who underwent surgery were enrolled into this study. Daily observation of the clinical signs of DVT was done post operatively until the subjects were discharged from the hospital. D-Dimer test and contrast venography were carried out on Day 2 and between Days 4 and 7 after surgery. Results were interpreted as normal and obstruction. There were 42 eligible patients, 18 of them (42.86 %) were diagnosed with DVT. We found that positive D-Dimer test (1.40), longer duration of surgery (1.86), and presence of clinical symptoms (1.09) increased the risk of the occurence of thrombosis although not statistically significant. There were four DVT patients who passed away within 4 months after surgery due to complication from DVT. The incidence of DVT in elderly with proximal femur fracture underwent surgery was relatively high (42.86 %) with the mortality rate was 22%.

Effectiveness of Cinnamon Oil Coating on K-wire as an Antimicrobial Agent against Staphylococcus Epidermidis.

BACKGROUND: Chronic osteomyelitis remains one of the common problems with the use of orthopaedic implants. Staphylococcus epidermidis is notorious for its biofilm formation on indwelling medical devices and is one of the most frequent pathogenic agents in chronic osteomyelitis. Cinnamon oil has been proven to be an effective antimicrobial agent against several bacteria, including S. epidermidis. The eradication of S. epidermidis and prevention of biofilm formation on medical devices are desirable outcomes. OBJECTIVE: To study the antimicrobial effect of cinnamon oil coating on K-wire against S. epidermidis and to quantify the most effective concentration of cinnamon oil coating on the K-wire. METHOD: The cinnamon oil was divided in ten different concentrations, from 0.002% to 1%, and subsequently applied to the Kirschner wire (K-wire). Its antimicrobial effect was determined by agar well diffusion method (MHA). Cinnamon oil coated K-wires were planted on S. epidermidis inoculated Muller-Hinton Agar (MHA) plate. The size of the zone of inhibition was recorded to the nearest mm, and this was compared to gentamycin, fosfomycin, vancomycin, netilmycin. RESULT: The cream based 1% concentration cinnamon oil coating on K-wire showed the strongest antimicrobial effect on S. epidermidis inoculated MHA plate. This was evident especially in the fourth repetition, with an inhibition zone diameter (IZD) of 19 mm. In the 1% concentration repetitions, the highest mean IZD of the 4 repetitions was 14 mm (intermediate according NCCLS). The mean IZD results demonstrate that cinnamon oil has 46.3% of the effectiveness of gentamycin, 49.1% of fosfomycin, 59.6% of vancomycin, and 43.4% of netilmycin. CONCLUSION: In this in-vitro study, cream based cinnamon oil coating on K-wire is effective against S. epidermidis, though less effective compared to gentamycin, fosfomycin, vancomycin and netilmycin. KEY WORDS: Cinnamon oil, K-wire, antimicrobial, S.epidermidis.

Mechanical properties of Indonesian-made narrow dynamic compression plate.

Osteosynthesis plates are clinically used to fixate and position a fractured bone. They should have the ability to withstand cyclic loads produced by muscle contractions and total body weight. The very high demand for osteosynthesis plates in developing countries in general and in Indonesia in particular necessitates the utilisation of local products. In this paper, we investigated the mechanical properties, i.e. proportional limit and fatigue strength of Indonesian-made Narrow Dynamic Compression Plates (Narrow DCP) as one of the most frequently used osteosynthesis plates, in comparison to the European AO standard plate, and its relationship to geometry, micro structural features and surface defects of the plates. All Indonesian-made plates appeared to be weaker than the standard Narrow DCP because they consistently failed at lower stresses. Surface defects did not play a major role in this, although the polishing of the Indonesian Narrow DCP was found to be poor. The standard plate showed indications of cold deformation from the production process in contrast to the Indonesian plates, which might be the first reason for the differences in strength. This is confirmed by hardness measurements. A second reason could be the use of an inferior version of stainless steel. The Indonesian plates showed lower mechanical behaviour compared to the AO-plates. These findings could initiate the development of improved Indonesian manufactured DCP-plates with properties comparable to commonly used plates, such as the standard European AO-plates.

Surface properties of Indonesian-made narrow dynamic compression plates.

The enormous need of orthopaedic (surgical) implants such as osteosynthesis plates is difficult to be fulfilled in developing countries commonly rely on imported ones. One of the alternatives is utilization of local resources, but only after they have been proven safe to use, to overcome this problem. Surface properties are some of the determining factors of safety for those implants. We have succeeded in developing prototype of osteosynthesis plate and the results indicate that Indonesian-made plates need improvement with regards to the surface quality of physical characterization.