Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
Objective To investigate the effectiveness of Kirschner wire combined with silk tension band in the treatment of ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint. Methods Between September 2008 and October 2011, 14 patients with ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint were treated using a combination of Kirschner wire and silk tension band. There were 8 males and 6 females, aged 23-55 years (mean, 40.8 years). The causes of injury were machinery twist injury in 5 cases, manual twist injury in 4 cases, falling in 4 cases, sports injury in 1 case. The time from injury to operation was 2 hours-14 days. All the patients presented pain over the ulnar aspect of the metacarpophalangeal joint of the thumb, limitation of motion, and joint instability with pinch and grip. The lateral stress testing of the metacarpophalangeal joint was positive. Function training was given at 2 weeks after operation. Results All incisions healed by first intention. The lateral stress testing of the metacarpophalangeal joint was negative. All the patients were followed up 6-18 months (mean, 13.1 months). The X-ray films showed good fracture reduction and healing with an average time of 7 weeks (range, 4-10 weeks). At last follow-up, the thumbs had stable flexion and extension of the metacarpophalangeal joint, normal opposition function and grip and pinch strengths. According to Saetta et al. criteria for functional assessment, the results were excellent in 11 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is an easy and simple method to treat ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint using Kirschner wire combined with silk tension band, which can meet the good finger function.
Objective To investigate the curative effects of open reduction and internal fixation with Kirschner wire for Mason type-II radial head or neck fracture in children. Methods From September 2007 to June 2009, 17 cases of Mason type-II radial head or neck fracture were treated, including 11 males and 6 femals with an average age of 8.5 years (4-11 years).The locations were left side in 5 cases and right side in 12 cases. All fractures were caused by fall ing and classified as Mason type- II fracture. Two cases compl icated by radial nerve deep branch injury. The time from injury to operation was 4 hours to 5 days. All cases received open reduction and internal fixation with Kirschner wire. They were evaluated by anteroposterior and lateral radiographs and functionally by Broberg criteria. Results Wound healed primarily in all patients. According to Métaizeau criteria, the results were excellent in 15 patients and good in 2 patients, who achieved anatomical reduction. Seventeen patients were followed up for a mean time of 14 months (6-25 months). Function returned to normal in 2 cases compl icated by radial nerve deep branch injury after 6 months of operation. No compl ications of infection and nerve injury occurred. The X-ray films showed that bony heal ing was achieved in all cases; the heall ing time was 2.0-3.5 months (mean 3 months). According to Broberg criteria, the outcome was excellent in 11 cases, good in 4 cases, and fair in 2 cases, the excellent and good rate was 88.2%. Conclusion Open reduction and internal fixation with Kirschner wire has good effect, satisfactory functional recovery and less compl ication in the treatment of Mason type-II fracture of radial head or neck in children.
To compare the effect and syndrome of treating intra-articular calcaneal fractures using Kirschner’s wire or AO calcaneal plate. Methods From March 2003 to March 2006, 71 cases (86 feet) of intra-articular calcaneal fractures were treated with Kirschner’s wire or AO calcaneal plate. Among them, 39 cases (48 feet) were treated using Kirschner’s wire, male 34, female 5. The age ranged from 15 to 64 years old, 36 on average. The course of illness was from 4 hoursto 10 days. There were 9 double side bone fractures and 30 one side bone fractures. Based on Sanders type, Type II were 40 feet, Type III were 7 feet and Type IV was 1 foot. The other 32 cases (38 feet) were treated using AO calcaneal plate, male 30, female 2. The age ranged from 18 to 55 years old, 33 on average. The course of illness was from 4 hours to 10 days. There were 6 double side bone fractures and 26 one side bone fractures. A total of 31 feet belonged to Sanders Type II, 5 to Type III, and 2 to Type IV. The 12-month follow-up, at least, was carried out in order to valuate the patients. The valuating items included: preoperative and postoperative Bohler’s angle and Gissane’s angle; heel bone height and width(contrast with the opposite side); to judge reposition circs by means of the CT scan and Borden’s judgment; function valuation adopting the American Orthopedic Foot amp; Ankle Society (AOFAS) grade point system. Results Patients with Kirschner’s wire fixed were followed up for 12 to 48 months, and AOFAS score ranged from 75 to 100 points, 90.6 on average. The excellent and good rate was 87.8%. The preoperative Bohler’s angle was from 0 to 10°, 7.8° on average, and postoperative from 30 to 40°, 33.2° on average. The preoperation Gissane’s anglewas 75 to 95°, 84° on average; and postoperative from 115 to 135°, 125° on average. There was significant difference (P lt; 0.05). The postoperative compl ications were that 1 foot was the incision edge shallow putrescence and 1 foot was the needle way infection. Patients with AO calcaneal plate fixed were followed up for 12 to 48 months, and AOFAS score was from 49 to 100 points, 87.5 on average. The excellent and good rate was 81.6%.There was no significant difference between the two groups (P gt; 0.05). The preoperative Bohler’s angle ranged from 0 to 15°, 6.5° on average, and postoperative from 25 to 40°, 30.2° on average. The preoperative Gissare’s angle was 72 to 92°, 80° on average; and postoperative from 115 to 130°, 120° on average. There was significant difference (P lt; 0.05). The postoperative compl ications were that 5 feet were the incision edge shallow putrescence, 1 was the common peroneal nerve hurt, and 1 was the petrous muscle aponeurotic inflammation. Conclusion There is no remarkable difference between the effects of treating intra-articular calcaneal fractures using plate or Kirschner’s wire, but the treatment with Kirschner’s wire is not only much easier and more economical, but has smaller wounds and fewer soft tissue problems.
Objective To study the feasibility of a new method for the cross-leg position maintained by the Kirschner wire internal fixation after the cross-leg flap procedure. Methods From December 2004 to October 2005, 5 patients (4 males, 1 female; aged 14-52 years) were admitted to our department, who suffered from the tibia exposure or the internal fixation plate exposure after operation because of the tibia fracture by trauma for 1-8 weeks. The soft tissue defects ranged in area from 2.4 cm × 2.0 cm to 4.2 cm × 3.0 cm. The soft tissue around the wound in the leg was too poor in condition to perform an operation of the local flap transplantation, but the wound and the tibia had no obvious infection, so an operation of the cross-leg flap transplantation was performed to cover the wounds. The operation was performed with the routine crossleg flap method introduced in the medical literature. After operation the cross-leg position was maintained through a simple internal fixation with two Kirschner wire, which were inserted through the tibia of the cross region of both thelegs, and layers of dressings were placed as a cushion between the crossed legsin case of the crushing skin ulcer formation. The effect of fixation, blood circulation in the cutaneous flap, and the stress of the pedicle were observed postoperatively. After 3-4 weeks the pedicle of the cross-leg flap was cut off; the crossed legs were detached and the Kirschner wire were pulled out. Results All the flaps survived with a good blood circulation and a low pedicle stress. The patients had a relatively comfortable position because all the areas of the legs could be allowed to make some motions except the cross-area ofthe legs. Another advantage of this fixation method was its convenience for observing the blood circulation of the cutaneous flap and for changing the dressings. Neither infection in the holes of the Kirschner wire nor crushing skin ulcer formation in the area of the cross-leg could be observed. The follow-up for 3-18 months revealed that all the flaps were in good condition with no edema, contracture or skin pigmentation. Conclusion The method of usingthe Kirschner wire to maintain the cross-leg position after the crossleg flapprocedure has more advantages than the plaster fixation. This improved method is simpler, and can achieve a tighter fixation in the crossleg area to maintainthe cross-leg position, allowing a micro-motion in other parts of the legs. The patients can have a relatively comfortable posture, and have a more convenient dressing changes and observation on the blood circulation in the flaps.