This study aims to compare the outcomes of Volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of distal radius fractures. We systematically searched multiple databases, including MEDLINE for randomized controlled trials (RCTs) comparing outcomes of VLP fixation and K-wire for treatment of distal radius fracture in adults. The methodological quality of each study was assessed by the Cochrane Risk of Bias tool. Patient-reported outcomes, functional outcomes, and complications at 1 year follow up were evaluated. Meta-analysis was performed using random-effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval (CI). 13 RCTs with 1336 participants met the inclusion criteria. Disabilities of the Arm, Shoulder and Hand (DASH) scores were significantly better for VLP fixation (MD= 2.15; 95% CI, 0.56-3.74; P = 0.01; I2=23%). No significant difference between the two procedures for grip strength measured in kilograms (MD= −3.84; 95% CI,-8.42-0.74; P = 0.10; I2=52%) and Patient-Rated Wrist Evaluation (PRWE) scores (MD= −0.06; 95% CI,-0.87-0.75; P = 0.89; I2=0%). K-wire treatment yielded significantly improved extension (MD= −4.30; P=0.04) but with no differences in flexion, pronation, supination, and radial deviation (P >0.05). The risk of complications and rate of reoperation were similar for the two procedures (P >0.05). This meta-analysis suggests that VLP fixation improves DASH score at 12 months follow up, however, the difference is small and unlikely to be clinically important. Existing literature does not provide sufficient evidence to demonstrate the superiority of either VLP or K-wire treatment in terms of patient-reported outcomes, functional outcomes, and complications

Our aim was to ascertain if K-wire configuration had any influence on the infection and complication rate for base of 4th and 5th metacarpal fractures. We hypothesised that in individuals whose wires crossed the 4th and 5th carpometacarpal joint (CMCJ), the rate of complications and infection would be higher. Data was retrospectively analysed from a single centre. 106 consecutive patients with a base of 5th (with or without an associated 4th metacarpal fracture) were analysed between October 2016 and May 2021. Patients were split into two groups for comparison; those who did not have K-wires crossing the CMCJ's and those in whose fixation had wires crossing the joints. Confounding factors were accounted for and Statistical analysis was performed using SPSS version 20 software. Of 106 patients, 60 (56.6%) patients did have K-wires crossing the CMCJ. Wire size ranged from 1.2-2.0 with 65 individuals (65.7%) having size 1.6 wires inserted. The majority of patients, 66 (62.9%) underwent fixation with two wires (range 1-4). The majority of infected cases (88.9%) were in patients who had k-wires crossing the CMCJ, this trended towards clinical significance (p=0.09). Infection was associated with delay to theatre (p=0.002) and longer operative time (p=0.002). In patients with a base of 4th and 5th metacarpal fractures, we have demonstrated an increased risk of post-operative infection with a K-wire configuration that crosses the CMCJ. Biomechanical studies would be of use in determining the exact amount of movement across the CMCJ, with the different K-wire configuration in common use, and this will be part of a follow-up study

The surgical correction of hammer digits offers a variety of surgical treatments ranging from arthroplasty to arthrodesis, with many options for fixation. In the present study, we compared 2 buried implants for arthrodesis of lesser digit deformities: a Smart Toe® implant and a buried Kirschner wire. Both implants were placed in a prepared interphalangeal joint, did not violate other digital or metatarsal joints, and were not exposed percutaneously. A retrospective comparative study was performed of 117 digits with either a Smart Toe® implant or a buried Kirschner wire, performed from January 1, 2007 to December 31, 2010. Of the 117 digits, 31 were excluded because of a lack of 90-day radiographic follow-up. The average follow-up was 94 to 1130 days. The average patient age was 61.47 (range 43 to 84) years. Of the 86 included digits, 48 were left digits and 38 were right. Of the digits corrected, 54 were second digits, 24 were third digits and 8 were fourth digits. Fifty-eight Smart Toe® implants were found (15 with 19-mm straight; 2 with 19-mm angulated; 34 with 16-mm straight; and 7 with 16-mm angulated). Twenty-eight buried Kirschner wires were evaluated. No statistically significant difference was found between the Smart Toe® implants and the buried Kirschner wires, including the rate of malunion, nonunion, fracture of internal fixation, and the need for revision surgery. Of the 86 implants, 87.9% of the Smart Toe® implants and 85.7% of the buried Kirschner wires were in good position (0° to 10° of transverse angulation on radiographs). Osseous union was achieved in 68.9% of Smart Toe® implants and 82.1% of buried Kirschner wires. Fracture of internal fixation occurred in 12 of the Smart Toe® implants (20.7%) and 2 of the buried Kirschner wires (7.1%). Most of the fractured internal fixation and malunions or nonunions were asymptomatic, leading to revision surgery in only 8.6% of the Smart Toe® implants and 10.7% of the buried Kirschner wires. Both the Smart Toe® implant and the buried Kirschner wire offer a viable choice for internal fixation of an arthrodesis of the digit compared with other studies using other techniques

Proximal inter-phalangeal joint . (PIPJ). arthrodesis is a commonly performed procedure as a part of hammer and claw-toe correction. Conventional K-wire stabilisation has the potential disadvantages of infection; violation of DIP joint; external protrusion or the wire and necessity of removal. Newer intra-medullary stabilisation devices are also available, though tend to incur addition costs. We present our technique and results of using a single, buried 1.6 mm K-wire for proximal inter-phalangeal joint fusion. Our objectives were to assess union rates and patient satisfaction following intra-medullary K wires for PIP joint fusion. This involved reviewing 26 consecutive patients (34 toes) who had undergone hammer or claw toe correction. Case notes and radiographs were reviewed to establish results and complications and the need for revision surgery. Initial Radiographs taken at 6 weeks and a telephone survey was undertaken to assess patient satisfaction (16–44 weeks). Our findings were that of the twenty-one women and five men underwent surgery, with a mean age of 59 years (24–77), stable union was achieved in 33 of 36 toes. No patients had superficial or deep infection and no patient required wire removal or a revision procedure. In conclusion, PIPJ Arthrodesis with buried K Wires has excellent clinical outcome and high patient satisfaction

Kirschner wires are commonly used in paediatric fractures, however, the requirement for removal and the possibility of pin site infection provides opportunity for the development of new techniques that eliminate these drawbacks. Bioabsorbable pins that remain in situ and allow definitive closure of skin at the time of insertion could provide such advantages. Three concurrent studies were performed to assess the viability of bioabsorbable pins across the growth plate. (1) An epidemiological study to identify Kirschner wire infection rates. (2) A mechanical assessment of a bioabsorbable pin compared to Kirschner wires in a simulated supracondylar fracture. (3) The insertion of the implants across the physis of sheep to assess effects of the bioabsorbable implant on the growth plate via macroscopic, pathohistological and micro-CT analysis. An infection rate of 8.4% was found, with a deep infection rate of 0.4%. Mechanically the pins demonstrated comparable resistance to extension forces (p=) but slightly inferior resistance to rotation (p=). The in vivo component showed that at 6 months: there was no leg length discrepancy (p=0.6), with micro-CT evidence of normal physeal growth without tethering, and comparable physeal width (p=0.3). These studies combine to suggest that bioabsorbable pins do not represent a threat to the growth plate and may be considered for physeal fracture fixation

Lisfranc injuries make up 0.2% of all fractures. With or without midfoot injuries, treatment requires early accurate diagnosis, anatomical reduction and stable internal fixation. Some surgeons prefer K-wire fixation, while others rely on rigid screw fixation, especially of the medial column. To assess the radiological and functional outcome of K-wire fixation of Lisfranc injuries, we carried out a prospective study between January 1999 and December 2000. The ages of our 15 male and four female patients ranged from 15 to 47 years. Using the Quenu and Kuss system to classify injuries, we treated five isolated, nine homolateral and five divergent injuries. In eight patients there were associated midfoot injuries, and four had compound fractures. We treated 11 fractures with closed reduction and K-wires. Open reduction with K-wire fixation was carried out on eight fractures, including the four compound fractures, within 19 days of admission. All patients were kept non-weight-bearing in a short backslab, and the wires removed at six weeks. Follow-up times ranged from 4 to 19 months. To assess functional outcome we used the American Orthopaedic Foot and Ankle Society’s midfoot scoring system, which has a maximum score of 100. The mean score of our patients was 70 (52 to 85). Mild or occasional foot pain and slight gait abnormality resulted in limitation of recreational activities. At three months, 15 patients were fully weight-bearing. A single case of superficial sepsis resolved, and there were no cases of implant failure or loss of reduction. K-wire fixation following anatomical reduction is a satisfactory option for the treatment of tarsometatarsal injuries, especially when severe injuries involve the midfoot. The technique is minimally invasive and the K-wires are easily inserted and removed

Mitchell – Hawkins osteotomy is a widely used technique for correction of mild to moderate hallux valgus. Several authors have recognised that, for a good result, the osteotomy must be stable enough to prevent excessive shortening or displacement of the distal fragment. Several fixation techniques have been proposed: sutures, staples, K-wires and screws. The aim of the study is to define whether the use of a screw could give better results than a single K-wire in the fixation of the osteotomy. We studied prospectively 30 patients with moderate hallux valgus operated on consecutively at our institute using the Mitchell osteotomy. In 15 patients (Group A) fixation was achieved with a single K-wire inserted through the tip of the toe and driven medial to the metatarsal head into the first metatarsal shaft, while in the others (Group B) a Herbert screw was used. All procedures were identical except for the fixation device and were carried out by the same surgeon. Weight bearing was allowed from the first day after surgery with a postoperative shoe. The K-wire was removed at the fifth postoperative week. In Group B the correct position of the great toe was maintained with a dressing, renewed weekly for 8 weeks after surgery. Patients were evaluated clinically with the AOFAS score and radiologically either before surgery and at the follow-up. The mean follow-up time was 10 months. We did not find any difference between the groups in correction of the intermetatarsal angle and of the valgus angle or in the improvement of the AOFAS score. No symptomatic displacement of the distal fragment occurred in either group. Five patients of Group A complained of a pin tract infection of the K-wire, which was treated successfully with oral antibiotics. No deep infection occurred. All the patients were satisfied with the treatment received but the majority of those of Group A (10/15) complained of discomfort in leaving the K-wire in place for such a long time. The Mitchell – Hawkins osteotomy can be fixed either with a K-wire or a screw with similar results in terms of angle correction and clinical scores. Patients felt more comfortable without protruding fixation devices, but for a successful procedure with the use of a screw, repeated dressing of the foot is required, which is time-consuming for both the surgeon and the patient

Background. Percutaneous K-wire fixation is a well-recognised and often performed method of stabilisation for distal radius fractures. However, there is paucity in the literature regarding the infection rate after percutaneous K-wire fixation for distal radius fractures. Aims. To analyse the rate and severity of infection after percutaneous K-wire fixation for distal radius fractures. Material and methods. Between October 2004 and June 2005, 43 patients with closed distal radius fractures had percutaneous K-wire fixation. The wires were left outside the skin in all the cases for easy removal at the end of six weeks at the clinic. They were followed up in the clinic at 1, 2, 4, and 6 weeks. The pin tracts were examined at 2 weeks and six weeks, or if needed earlier. The severity of pin tract infection was graded using modified Oppenheim classification. Results. Out of 43 patients, the male to female ratio was 13:30. The mean age was 49.1 years (range 5-86 years). There were nine cases of pin tract infection, out of which three were grade I, three were grade II, two were grade III, and one was grade IV. In three cases the K-wires had to be removed earlier. Discussion. The infection rate after percutaneous K-wire fixation for distal radius fractures is high (20.9%), which is equivalent to the infection rate quoted in the literature for hybrid external fixators. As the K-wires are used to fix the fractures, the expected implant infection rate in Trauma and Orthopaedics which is less than 1% should be aimed for. However this is not the case. Hence, burying the K-wires under the skin may be an alternative to reduce the infection rate after percutaneous K-wire fixation of distal radius

Conservative treatment of the ‘boxer’s fracture’ gives acceptable functional results but often leaves the patient with a residual deformity. Using a prograde intramedullary K-wire, we treated 23 consecutive patients with a fractured neck of the fifth metacarpal. Volar angulation exceeded 40°. A 1.6-mm pre-bent K-wire was inserted via the base of the fifth metacarpal in each case. Time to regaining full function, time to union and final functional and radiological outcome were recorded. All 23 patients went on to full clinical and radiological union within six weeks. In 18 patients, the reduction was anatomical with no residual angulation. In five the residual angulation ranged from 5° to 15°, with a mean of 8°. There was a transient sensory neuropraxia in two patients. This minimally invasive technique is a simple, cost-effective and reliable method of treating a ‘boxer’s fracture’ and ensures a rapid return to full function with little or no residual deformity

Introduction. Bone marrow stimulation has been a successful treatment option in cartilage repair and microfracture was the procedure of choice since the late 1980s. Despite its success in young and active patients, microfracture has inherent shortcomings such as shallow channels, wall compression, and non-standardized depth and diameter. This in vitro study assessed bone marrow access comparing microfracture, 1 and 2mm K-Wires, 1mm drill, and a recently introduced standardized subchondral bone needling procedure (Nanofracture) that creates 9mm deep and 1mm wide channels. Methods. An adult ovine model was used to assess access to bone the marrow spaces as well as effects on bone following microfracture, nanofracture, K-wire, and drilling following ethical clearance. All bone marrow stimulation techniques were conducted on a full thickness articular cartilage defect on the medial femoral condyles by the same surgeon. The same groups were repeated in vitro in 4 paired ovine distal femurs. MicroCT (Inveon Scanner, Siemens, Germany) was performed using 3D reconstruction and 25 micron slice analysis (MIMICS, Materialise, Belgium). Results. Microfracture elicited shallow depth with bone compression surrounding the channels. Trabecular channel access was limited; the channel depth and diameter were non-standardized and highly user and instrument dependent. Nanofracture demonstrated deep cancellous bone perforation with a high number of open trabecular channels. K-Wire drilling with both diameters resulted in well-defined channel walls, outlined by fine osseous deposits. Trabecular channel access was limited. The diameter of bone perforation is standardized, but depth is defined by visual controls. 1mm drill bit reaming demonstrated better osseous evacuation, but still limited trabecular marrow access. Discussion and Conclusion. Nanofracture resulted in thin, fragmented cancellous bone channels without rotational heat generation. Compared to microfracture, drilling and K-Wire stimulation, nanofracture showed superior bone marrow access with multiple trabecular access channels extending 9mm into subchondral bone

Purpose: This study compares clinical and radiological outcomes of K-wire fixation with volar locking plate (i.e. fixed angle) fixation in unstable, dorsally angulated, distal radius fractures. Materials and methodology: Fifty four adult patients with an isolated, closed, unstable, dorsally angulated fracture without articular comminution were randomised to closed reduction and K-wire fixation (3 wires) or volar locking plate fixation. All were immobilised in a cast for six weeks and prescribed physiotherapy. Independent clinical and radiological assessment was performed at 3 and 6 months post injury, using the DASH and Gartland & Werley scoring systems. Results: Twenty-four patients were treated with a plate and thirty with K-wires. There were no complications in the plate group. There were 9 complications in the K-wire group. Three patients required re-operation (for malunion, median nerve compression, and retrieval of a migrated wire). Remaining complications included: 5 pin-site infections and 1 superficial radial nerve palsy. Plate fixation achieved statistically significant better radiological and functional results. Conclusion: Volar locking plate fixation achieves better radiological and functional results with fewer complications than K-wire fixation in unstable, dorsally angulated, distal radius fractures

Thermal osteonecrosis is a side effect when used Kirschner (K) wires and drills in orthopaedic surgeries. This osteonecrosis may endanger the fixation. Orthopaedic surgeons sometimes have to use unsharpened K-wires in emergent surgery. The thermal effect of used and unsharpened K wire is ambiguous to the bone. This experimental study aims to assess the thermal osteonecrosis while drilling bone with three different types of K-wires especially a previously used unsharpened wire and its thermographic measurements correlation. Two different speeds of rotation were chosen to investigate the effect of speed on thermal necrosis to the bone. A total of 16 New Zealand white rabbits weighing a mean of 2.90 kg (2.70 – 3.30 kg) were used. All rabbits were operated under general anaesthesia in a sterile operating room. Firstly, 4 cm longitudinal lateral approach was used to the right femur and then the femur was drilled with 1.0 mm trochar tip, spade tip and previously used unsharpened K-wires and 1.0 mm drill bit at 1450 rpm speed. Left femur was drilled with same three type K-wires and drill bit at 330 rpm speed. One cm distance was left among four penetrations on the femur. The thermal changes were recorded by Flir® E6 Thermal Camera from 50 cm distance and 30-degree angle. Thermographic measurements saved for every drilling process and recorded for the highest temperature (°C) during the drilling. All subjects were sacrificed post-operatively on the eighth day and specimens were prepared for the histological examination. The results of osteonecrosis assessment score and thermographic correlation were evaluated statistically. Histological specimens were evaluated by the scoring of osteonecrosis, osteoblastic activity, haemorrhage, microfracture and inflammation. Results were graded semi-quantitatively as none, moderate or severe for osteonecrosis, haemorrhage and inflammation. The microfracture and osteoblastic activity were evaluated as present or absent. There was no meaningful correlation between osteonecrosis and the drilling speed (p=0.108). There was less microfracture zone which was drilled with trochar tip K-wires at 1450 rpm speed (p=0.017). And the drilling temperature of trochar tip K-wires was higher than the others(p=0.001). Despite this evaluation, osteonecrosis zone of spade and unsharpened tip K-wires were more than trochar tip K-wires (p=0.039). The drill bit at 330 rpm caused the least osteonecrosis and haemorrhage and respectfully the lowest drilling temperature (p=0,001). The osteoblastic activity shows no difference between the groups. (p=0,122; 0,636;0.289). On the contrary to the literature, our experiment showed that there is no meaningful correlation between osteonecrosis score and temperature produced by drilling. The histological assessment showed the osteonecrosis during short drilling time but, not clarify the relation with drilling temperature. Eventually, the osteonecrosis showed a positive correlation with drilling time independently of drilling temperature at 330 rpm. (p=0,042) These results show that we need more studies to understand about osteonecrosis and its relationship with drilling heat temperature. Trochar tip K-wires creates higher drilling temperature but less osteonecrosis than a spade and unsharpened cut tip K-wires. Using unsharpened tip K-wire causes more osteonecrosis. Previously used and, unsharpened K-wires should be discarded

The aim of this study is to compare functional, clinical and radiological outcomes in K-wire fixation versus volar fixed-angle plate fixation in unstable, dorsally angulated distal radius fractures. Fifty-four adult patients with an isolated closed, unilateral, unstable, distal radius fracture were recruited to participate in the study. Only dorsally displaced fractures with no articular comminution were included. Patients were randomised to have their fracture treated with either closed reduction and K-wire fixation (3 wires) or fixed-angle volar plating. Both groups were immobilised in a below elbow cast for six weeks. The wires removed in the outpatients at six weeks and both groups were referred for physiotherapy. Independent clinical review was performed at three and six months post injury. Functional scoring was performed using the DASH and Gartland and Werley scoring systems. Radiographs were evaluated by an independent orthopaedic surgeon. Twenty-five patients were treated with a plate and twenty-nine with wires. There were no complications in the plate group. There were 9 complications in the K-wire group with 3 patients requiring a second operation (1 corrective osteotomy for malunion, 1 median nerve decompression and 1 retrieval of a migrated wire). The remaining complications included: 5 pin site infections (3 treated with early pin removal and 2 with oral antibiotics only), and 1 superficial radial nerve palsy. There were no tendon ruptures. Both groups scored satisfactory functional results with no statistical difference. There was a statistically significant difference in the radiological outcomes with the plate group achieving better results. We conclude that in unstable dorsally angulated distal radius fractures volar fixed-angle plate fixation is able to achieve comparable functional results to K-wire fixation with better radiological results and fewer complications. This has resulted in a change in our clinical practice

Aim: We report radiological outcome following percutaneous minimally invasive corrention of Hallux Valgus using K-wire fixation. Methods: We followed 15 patients (11 bilateral operations) who had above procedure for Hallux Valgus deformity correction. All patients had pre operative and post operative x-rays assessed for Hallux Valgus angle, 1st Intermetatarsal angle and Distal Metatarsal Articular angle. We also collected clinical data including deformity correction and complications. Results: Mean age of the patients was 55.47(SD 14.27). Of the 15 procedures 11 had bilateral operations and 4 had only one side operated (total 14 right sided 12 left sided operations). Mean duration of follow up was 85.47 days (range 29 to 259). The pre operative mean Hallux Valgus angle was 37.05(SD 6.49, range 28 to 49) where as post operative it was 11.32(SD 9.07, range 0 to 33). The pre operative mean 1st Intermetatarsal angle was 16.46(SD 2.74, range 11 to 21) where as post operative it was 5.48(SD 3.62, range 1 to 16). The pre operative mean Distal metatarsal articular angle was 35.36(SD 8.38, range 18 to 51) where as post operative it was 8.29(SD 9.13, range 0 to 38). Clinically one great toe had infection post operatively requiring early removal of K-wires resulting in residual deformity. One had mild bilateral recurrence, two had mild unilateral recurrence. These patients did not require any further surgery. Conclusion: Above results indicate that Percutaneous Minimally invasive Hallux Valgus correction using K-wire fixation showed good radiological correction in various angles measured to quantify Hallux Valgus deformity

Fractures of the femoral head are a challenging problem. The most often performed head preserving procedure worldwide is closed reduction and insertion of cannulated screws under fluoroscopic control. The use of navigation is still experimental in general trauma since rigid reference markers must be attached to all fragments. The examined system (Surgix®, Tel Aviv, Israel) is a fluoroscopy based image analysing system. It consists of a workstation and X-ray opaque markers in surgical tools. When the tool is visible in a C-arm shot a trajectory is displayed as additional layer in the image to serve as guidance for the surgeon. Forty synthetic femurs (Synbone®, Malans, Switzerland) were used and placed inside foam to simulate the soft tissue of the thigh. The models were equipped with 4.5mm radio-opaque markers at the fovea capitis femoris as target point. The aim was to bring the tip of a K-wire as close as possible to the target point entering the bone at the lateral base of the greater trochanter in a center-center position. Twenty were done under image guidance and 20 were operated the conventional way. Outcome measures included the accuracy (the distance between the tip of the wire and the target in a CT), the number of guide wire insertions, procedure duration, radiation exposure and learning curve. In the image guided group optimal guide wire placement was accomplished on first pass in 65% of the cases as compared to 5% in the conventional group (p = < 0.0001). The average number of trial and error was significantly lower in the guided group (1.7 vs. 5.8, p = < 0.0001). Consequently the average duration of the guided procedure was significantly shorter (p = 0.0008) along with radiation exposure time reduced by over 70% (p = 0.0002). The guidance system hit averaged 5.8 mm off target as compared to 5.3 mm for the freehand method (p = 0.3319). Image based guidance significantly shortened the procedure, reduced the radiation exposure and the number of trials without changing the surgeons workflow and can be used in trauma cases were reference marker based navigation is not applicable

The internal fixation of scaphoid bone fractures remains technically difficult due to the size of the bone and its three- dimensional shape. Early rigid fixation, e.g with a screw, has been shown to support good functional outcome. In terms of stability of the fracture, biomechanical studies have shown a superior result with central screw placement in the scaphoid in comparison with an eccentric position, which can lead to delayed or non-union. Image-based navigation could be helpful for these cases. The main limitation of reference-based navigation systems is their dependence on fixed markers like used in modern navigation systems. Therefore it is limited in treatment of small bone fractures. In former experimental studies 20 artificial hand specimens were randomised into two groups and blinded with polyurethane foam: 10 were treated conventionally and 10 were image guided. For trajectory guidance a reduction of duration of surgery, radiation exposure and perforation rate compared to the conventional technique could be found. Accuracy was not improved by the new technique. The purpose of this study was to identify the possible advantages of the new guidance technique in a clinical setting. In this prospective, non-randomised case series we tested the feasibility of the system into the accommodated surgical workflow. There was no control group. Three cases of scaphoid fractures were included. All of the patients were treated with a cannulated screw following K-wire placement via the percutaneous volar approach described. In addition, length measurements and screw sizes were determined using special features of the system. The performing surgeon and two attending assistant doctors (one assisting the surgical procedure, one handling the guidance system) had to rate the system following each procedure via a user questionnaire. They had to rate the system's integration in the workflow and its contribution to the success of the surgical procedure in percentages (0 %: totally unsuccessful; 100 %: perfect integration and excellent contribution). All of the clinical procedures were performed by the same surgeon. The surgeons rated the system's contribution and integration as very good (91 and 94 % of 100 %). No adverse event occurred. An average of 1.3 trials ± 0.6 (1; 2) was required to place the K-wire in the fractured scaphoid bone. The dose-area product was 19 cGycm2 ± 3 (16; 22). The mean incision until suture time was 36.7 min ± 5.7 (30; 40). For clinical cases, the system was integrated and rated as very helpful by users. The system is simple and can be easily integrated into the surgical workflow. Therefore it should be evaluated further in prospective clinical series

The authors report their results of “extension-block Kirschner wire fixation” for the treatment of mallet finger fracture. This technique should be considered in presence of a large bone fragment involving more than the 30% of the articular surface, with or without palmar subluxation of the distal phalanx. A modification of the extension-block technique is described reducing the fragment to 0° extension of the distal interphalangeal joint. The results confirmed the better outcomes of this modification, minimizing the postoperative extension lag at the distal interphalangeal joint. The Wehbe and Schneider method was used to classify the mallet finger fractures and the results were graded according to Crawford’s criteria (66,6% excellent and 33,4% good). The extension-block K wire technique, when properly applied, is a very helpful procedure avoiding the risks and complications of the open surgery and achieving a good indirect anatomical reduction of the fracture

The use of percutaneous Kirschner wires [K-wires] and plaster is a popular method of treatment for displaced distal radius fracture. However, multi-database electronic literature review reveals unsurprisingly different views regarding their use. From August 2002 till June 2004, 280 distal radial fractures were admitted to our orthopaedic department. They were recorded prospectively in the departmental trauma admissions database. We studied the 87 cases treated with the K-wires and plaster technique. They were classified according to the AO classification system. The mean patient age was 53 [5-88] years. The mean delay before surgery was 7 [0-24] days. We studied the complications reported by the attending orthopaedic surgical team. 48 out of 87 patients [55.1%] were reported to have complications. We analysed the displacement and the pin tract infection, as they were the main reported complications. 28 out of 87 patients [32%] had displacement [9 had further surgery to correct the displacement, 19 did not have any further surgery as the displacement was accepted]. 11 out of 87 patients [12.6%] had pin tract infection [7 needed early removals of the K-wires and systematic treatment]. Further analysis showed no statistically significant relation between the complications rate and the age of the patients, the delay before surgery or the type of the fractures. We demonstrate a considerable high displacement and infection rate with the use of K-wires and plaster technique for fixation of distal fracture irrespective of the age of the patients, the delay before surgery or the fracture classification. There are other methods for fixation of the distal radial fracture with proven less morbidity which should be considered

The Kramer osteotomy for hallux valgus deformity was described in 1990 and has been performed by the senior author in our unit since 1999. The procedure involves a wedge excision of bone and lateral displacement of the first metatarsal head. The osteotomy is splinted by a K-wire passed medially to the phalanges and metatarsal head into the metatarsal diaphysis. During the period October 1999 to December 2001 this procedure was performed on 26 feet in 24 patients. Case notes were reviewed retrospectively to assess the subjective outcome following the operation. Patients were invited to attend a follow up clinic to assess the outcome using the Hallux Metatarsal-Interphalangeal Scale (HMIS) of the American Orthopaedic Foot and Ankle Society and weight bearing radiographs of the foot. Twelve patients (13 feet) were seen at this follow up. Discharge from hospital was on the day following surgery in 20/24 patients with three days maximum stay. K-wires and plaster boots were left in situ for 41 days on average (30–50 days range). From the case notes, using absence of hallux pain, deformity, hallux stiffness and footwear problems as outcome measures, 20 feet (77%) had a good outcome, five feet (19%) had a fair outcome and one foot (4%) had a poor outcome. At the follow up clinic at a mean time from operation of 134 weeks (range 56–153 weeks), the average HMIS score was 86/100 (Range 60–100) with 77% scoring 85 or more out of 100. Average postoperative intermetatarsal, hallux valgus and distal metatarsal articular angles were 6.9, 15.8 and 11 degrees respectively. Other than six cases of minor infection of skin, treated empirically with antibiotics, no other complications were seen. All patients were happy they had received this treatment. In conclusion the Kramer osteotomy is a technically simple operation which gives good results with few complications

Aims: We reviewed 100 paediatric lateral condylar fractures of the elbow treated with k-wire þxation. We compared the complication rates of wires left percutaneous versus wires buried beneath the skin. Methods: 68 patients had wires left percutaneous and 32 patients had their wires buried. Fractures were classiþed as displaced or undisplaced. Lengths of time for Ôwires in situñ, limb immobilisation and follow up were recorded. All complications of treatment and outcomes were recorded. Results were analysed using Chi-square tests. Results: Buried k-wires stayed in situ longer than percutaneous wires (average 6.7 versus 4.9 weeks). Fracture types along with mean lengths of immobilisation and follow up were similar for both groups. In the Ôburiedñ group 6 (19%) patients wires migrated through the skin although only 1 (3%) case became infected. 1 (3%) patient developed an uncomfortable heterotrophic ossiþcation. In the Ôpercutaneousñ group 20 (29%) patients developed wire infection and/or granulation tissue requiring treatment. 3 (4%) of these cases severely compromised treatment. Delayed union requiring re-operation occurred in 1(1%) patient. Conclusion: Burying the wires after open reduction and þxation of lateral condylar fractures signiþcantly (p=0.0026) reduces the incidence of infection and overgranulation associated with the wires