Intramedullary fixation using Kirschner wires in children with osteogenesis imperfecta.

BACKGROUND: Surgical treatment for osteogenesis imperfecta (OI) remains controversial. The use of elongating rods has become a mainstay in this treatment, and there have been many reports of the results of this procedure. In contrast, using nonelongating rods is considered to be the classic method. This older method is still used by surgeons who are concerned about the possibility of trauma on the articular surface due to arthrotomy at the insertion of the elongating rod or who are working in developing countries with fewer resources. We are among those who prefer the use of nonelongating rods to elongating rods. This article presents the results of intramedullary fixation using nonelongating rods such as Kirschner wires (K-wires) in children with OI and the proper timing of wire exchange to prevent further fracture. METHODS: We treated 29 femora in 17 patients with OI by means of stabilization using K-wires. For these patients we calculated revision-free survival and analyzed the details of any fractures that occurred after the primary surgery. We also investigated the relations between the wire length ratio, which was defined as the ratio of the intramedullary wire length divided by the femoral length, and the fracture type. RESULTS: The revision-free survival for the 29 primary procedures was 63% at 3 years, and 36% at 5 years. All fractures that occurred at the wire tip required additional surgery, whereas only 51% of fractures at other sites required additional surgery. The wire length ratio of wire-tip fractures was significantly lower than that of fractures at other sites. There is a significant difference in the incidence of wire-tip fractures and other fractures between ratios of 65% and 75%. CONCLUSIONS: Wire exchange surgeries should be performed before the wire length ratio drops to <70%. This information could be useful for preventing further fractures that require surgery when OI patients are treated by intramedullary fixation with nonelongating rods. LEVEL OF EVIDENCE: Level IV.

[Metacarpal fractures--treatment results]. / Zlamania kosci sródreccza--wyniki leczenia.

In the study we presented the results of treatment of 126 fractures in patients hospitalized between 1994-2003 in the Department of Orthopeadics. The assesment was based on 87 patients that presented for the study, including 62 male and 25 female patients in the 14-57 age. The treatment consisted of stationary reduction combined with cast fixation and stabilization with Kirschner wire. The results were dividet into 5 groups based on the fractured metacarpal bone. The best results have observed the couse of treatment of 2nd, 3rd, 4th metacarpal fracturs and not so good in the 1st and 5th metacarpal fractures.

Kirschner wire pin tract infection rates between percutaneous and buried wires in treating metacarpal and phalangeal fractures.

OBJECTIVE: To compare pin tract infection rate between percutaneous and buried placement of Kirschner (K-) wiring for hand fractures. STUDY DESIGN: Quasi--experimental study. PLACE AND DURATION: Plastic, Reconstructive, Hand and Burn Surgery Unit, Liaquat National Hospital, Karachi, from September 2005--February 2006. PATIENTS AND METHODS: Patients with fractures of metacarpals and phalanges of hand were selected by non-probability purposive method. Assessment of pin tract infection by clinical examination and pin tract scoring was done by modification of Oppenheim classification. Statistical analysis was done using Chi-square test. RESULTS: Ten out of 55 percutaneous and 2 out of 45 buried wires were infected. The difference in infection rates of two groups was statistically significant at p<0.05. Three percutaneous, but not buried Kirschner wires, had to be removed before 4 weeks because of failure to respond to local wound care and oral antibiotics. CONCLUSION: Percutaneous K- wires had significantly greater infection rate than wires which were buried deep to the skin.

Análise metalográfica e de microscopia eletrônica de varredura do fio de aço inoxidável 316L, deformado e implantado no tecido muscular de rato / Scanning electron microscopy and metalographic analysis of the 316L stainless steel wire deformed and implanted in the muscular tissue of rat

O fio de aço inoxidável 316L, reto ou deformado por torçäo, foi analisado através de microscopia eletrônica de varredura (MEV) e metalografia. A torçäo aumentou as linhas de segregaçäo, deformou a superfície e gerou tensäo na estrutura interna do metal. Após 120 dias de implantaçäo no tecido muscular de rato, o fio reto apresentou fendas rasas, e no torcido observaram-se fendas profundas, sugestivas de processo corrosivo. Estes resultados mostraram que o fio 316L sofre modificaçöes após a torçäo, que säo acentuadas com a implantaçäo. Períodos mais longos de observaçäo säo necessários para melhor avaliar as alteraçöes do fio 316L, particularmente corrosäo provocadas pela implantaçäo