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Seong Jae Hong - One of the best experts on this subject based on the ideXlab platform.
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K-Wire Breakage During Metalware Removal Due to a Defective K-Wire Shaft
Archives of Plastic Surgery, 2013Co-Authors: Seong Jae Hong, Su Rak EoAbstract:Since its introduction in 1909 by Martin Kirschner, K-wire fixation with sterilized, sharpened, smooth stainless steel pins has been the most available and forgiving technique for the fixation of most Fractures and dislocations in the Hand and wrist. K-wires have been widely used in bone operations due to their simplicity, reliability, and cost-effectiveness. According to a biomechanical study, K-wires offer a rigidity similar to interosseous wiring and other methods of fixation [1]. However, several reports have described complications resulting from the use of K-wires. Botte et al. [2] reported a complication rate of 18%, including pin loosening, pin tract infection, and pin bending. Although they were easily resolved by removal of the pin without permanent sequelae, some authors have described life-threatening complications, such as, distant migration to a vital organ [3]. Until now, no case report has described K-wire breakage due to a manufacturing defect. We describe the breakage of a K-wire during removal resulting in a permanently retained remnant in the medullary cavity. A 15-year-old male was admitted to our hospital with right Hand swelling and pain. Plain radiography revealed an oblique Fracture in his right index metacarpal shaft with a dorsal apex angulation of 25 degrees. Under axillary block anesthesia, a tourniquet was applied to the upper arm at 250 mm Hg, and under fluoroscopic guidance, the Fractured index metacarpal was reduced using the Jahss maneuver. The metacarpophalangeal (MP) joint and the proximal interphalangeal (PIP) joint were flexed at 90 degrees and upward pressure was applied on the flexed finger to correct dorsal apex angulation. After reduction, two 1.1 mm thick K-wires were inserted from the sides of the second MP joint to the metacarpal base. The locations K-wires were checked using a fluoroscope, and the distal sharp ends were cut to leave a 1 cm length of wire (Fig. 1). To immobilize the Fractured segment, a short arm splint was applied. A week later, the short arm splint was removed and active range of motion was allowed. At 6 weeks postoperatively, radiologic union was achieved using plain radiography, and we attempted to extract the two K-wires. One of the K-wires was completely removed but the other broke at its mid-shaft (Fig. 2), leaving the remnant proximal portion buried in the medullary cavity (Fig. 3). Subsequently, the patient was able to flex and extend the MP joint fully and no symptoms such as pain, bleeding, or swelling were encountered. We noticed that the tip of the broken K-wire resembled the tip of the intact extracted wire. To determine the cause of the breakage, both K-wires were sent to the head office of the manufacturer (Solco Biomedical Co., Ltd., Pyeongtaek, Korea). We observed that the broken tip resembled the end of a normal K-wire tip in magnified view (40× magnification) (Fig. 4), signifying that the breakage was caused by a manufacturing defect. Fig. 1 A 15-year-old male had an oblique Fracture on the shaft of the right second metacarpal. A plain radiograph taken 4 weeks after surgery shows the two K-wires placed after reduction of the right index metacarpal. Fig. 2 The two extracted K-wires. The upper one is the broken K-wire and the lower one is the normal K-wire. Fig. 3 Plain radiograph obtained at 6 weeks postoperatively, showing the residual K-wire portion in the medullary cavity. Fig. 4 The tip of the broken K-wire was relatively sharp and had the same angle as the normal K-wire (40× magnified). K-wires are widely used for temporary fixation during Hand Fracture operations, and can be easily inserted and removed after bone union. K-wire fixation is a common and versatile method of achieving the internal fixation of Fractures in the Hand and wrist, and can be used to treat mallet finger and perform arthrodesis. Nevertheless, complications of K-wire fixation have often been reported [2]. These complications could be classified as Fracture-fixation-related or pin-related. The majority of Fracture-fixation complications involve pin loosening due to poor initial pin placement. Accurate reduction and pin insertion must be confirmed by intraoperative X-ray fluoroscopy, and if loosening is recognized, the pin should be removed to reduce the risk of complications, which include infection, migration, and nerve and tendon injury. Pin tract infections, which are the most common pin-related complications, can be treated by preventing motion, oral antibiotics, and pin removal [4]. Osteomyelitis is a major complication of K-wire fixation. Botte et al. [2] observed the development of osteomyelitis from a pin tract infection in 1% of patients. Pin migration from a shoulder or upper extremity to the heart or major vessels has already been described by Lyons and Rockwood [3]. They reported 49 cases of K-wire migration, which included 17 to major vascular structures and 8 deaths, and found that the migration of K-wires used to fixate the shoulder girdle was responsible. Tendon injury has been reported infrequently. Botte et al. [2] described two cases of FDP tendon entanglement. Neurological complications can also occur. Gosens and Bongers [5] reported a neurological problem rate of 16.5% among 200 patients. All recovered without sequelae, though one with persistent radial nerve palsy required a graft from the sural nerve. This report is the first to document K-wire breakage due to a manufacturing defect. It was difficult to identify the shaft defect responsible intraoperatively because the broken wire had an appearance similar to the normal wire. In fact, the defect was noticed only after pin removal and close examination of the broken tip. K-wires are used for various functions, but are not always safe. Complications are an unavoidable consequence of surgical procedures, and thus, it is important to recognize their causes and prevent repeat incidents. Our experience in the described case cautions that potential complications resulting from K-wire defects should be borne in mind.
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Percutaneous Multiple Kirschner Wire Fixation in the Treatment of Hand Fractures
Journal of the Korean Society for Surgery of the Hand, 2013Co-Authors: Seong Jae Hong, Hyeung Gyo Seo, Jong Ick Whang, Sanghun ChoAbstract:The Hand Fracture is one of the most common traumas, and it accounts for up to 10% of all the human body Fractures. Its etiologic factors include sports activities, traffic accidents and industrial work activities. There is a variability in the management of Hand Fracture. This poses challenging problems for surgeons. The treatment goal is to obtain good outcomes, for which surgeons should consider 1) restoration of the normal alignment, 2) achievement of the appropriate union, 3) recovery of the early range of movement and earlier return to full activities, and 4) absence of residual disabilities or deformities It is difficult to maintain reduction without causing undesirable side effects. The complications of Hand Fracture include infection, non-union, malunion, tendon adhesion and joint stiffness. Of these, the most serious potential problem is an inability to attain a full range of movement. There Percutaneous Multiple Kirschner Wire Fixation in the Treatment of Hand Fractures
Xu Jianguang - One of the best experts on this subject based on the ideXlab platform.
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Internal fixation with AO mini-plate for treatment of Hand Fractures
Chinses Journal of Hand Surgery, 2002Co-Authors: Xu JianguangAbstract:Objective To study the treatment outcome of internal fixation with AO mini plate in the treatment of Hand Fractures.Methods From October 1999 to October 2001, open reduction and internal fixation with AO mini plate were done in 31 cases of metacarpal and phalanx Fracture (42 lesions).Results External fixation lasted 2 ～ 3 days (average 2.3 days). The bone union of roentgenographic evidence was at 2 ～ 4 weeks (average 2.6 weeks). The patients went back to their jobs between 3 ～ 12 weeks (average 4.6 weeks).Conclusion Internal fixation with AO mini plate in treatment of Hand Fracture can shorten the time of postoperative external fixation and bone union,and make patients return to work earlier.
Steven E.r. Hovius - One of the best experts on this subject based on the ideXlab platform.
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Rewarming patterns in Hand Fracture patients with and without cold intolerance.
The Journal of hand surgery, 2011Co-Authors: Ernst Smits, Tim H.j. Nijhuis, Ruud W. Selles, Steven E.r. Hovius, Frank J. P. M. Huygen, Sjoerd P. NiehofAbstract:Purpose It is often assumed that cold intolerance is associated with abnormalities in the skin temperature due to changes in the blood flow of the Hands. In this study, we determined whether patients with and without cold intolerance after a Hand Fracture or healthy controls have a diminished rewarming after a cold stimulus. Methods The severity of cold intolerance was evaluated using the Cold Intolerance Symptom Severity (CISS) questionnaire. To determine whether abnormal rewarming plays a major role in the underlying pathophysiology of cold intolerance, a cold-stress test was applied at a mean of 30 months (with a range of 11 mo) after the patients recovered from a Hand Fracture. A control group also underwent identical cold-stress testing for comparison. Temperature during the rewarming phase was measured using videothermography. Results Thirteen control subjects and 18 patients participated. Control subjects did not report any symptoms of cold intolerance (CISS score, 0) and no loss of sensibility was measured. The mean CISS score of all patients was 27.8; 9 patients scored above the cut-off value for normal cold intolerance. No significant differences were found in the rewarming patterns between (1) the affected and non-affected Hand of the postFracture patients, (2) the dominant and non-dominant Hand of the control subjects, and (3) the patients and controls. Conclusions The results of this study revealed no relation between the severity of cold intolerance and rewarming patterns after cold stress testing. This might suggest that temperature regulation of the Hands in post-Fracture patients might not be responsible for the symptoms of cold intolerance, based on cold-stress test response. Type of study/level of evidence Prognostic II.
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Prevalence and severity of cold intolerance in patients after Hand Fracture
The Journal of hand surgery European volume, 2009Co-Authors: Tim H.j. Nijhuis, Ernst Smits, Jean Jaquet, F.j.t. Van Oosterom, Ruud W. Selles, Steven E.r. HoviusAbstract:Cold intolerance is a well-known phenomenon that develops in the first months after Hand injury and generally does not decrease over time. In this study, we evaluated the prevalence and severity of cold intolerance after Hand Fracture in 129 patients using the Cold Intolerance Symptom Severity (CISS) questionnaire. Patients with nerve and/or vascular injuries were excluded. The response rate was 59%. The mean CISS score was 23. Pathological cold intolerance, defined as a CISS score over 30, was experienced by 38% of the patients. Cold intolerance is common after Hand Fractures and can be severely disabling in some patients.
James H Mcauley - One of the best experts on this subject based on the ideXlab platform.
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persistent pain after wrist or Hand Fracture development and validation of a prognostic model
Journal of Orthopaedic & Sports Physical Therapy, 2019Co-Authors: Aidan G Cashin, Adrian C Traeger, Markus Hubscher, Lorimer G Moseley, Flavia Di Pietro, Luke Parkitny, James H McauleyAbstract:Background Worldwide, the incidence of wrist Fracture is increasing. There are currently no externally validated prognostic models to inform early decision making for these patients. Objectives To ...
Su Rak Eo - One of the best experts on this subject based on the ideXlab platform.
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K-Wire Breakage During Metalware Removal Due to a Defective K-Wire Shaft
Archives of Plastic Surgery, 2013Co-Authors: Seong Jae Hong, Su Rak EoAbstract:Since its introduction in 1909 by Martin Kirschner, K-wire fixation with sterilized, sharpened, smooth stainless steel pins has been the most available and forgiving technique for the fixation of most Fractures and dislocations in the Hand and wrist. K-wires have been widely used in bone operations due to their simplicity, reliability, and cost-effectiveness. According to a biomechanical study, K-wires offer a rigidity similar to interosseous wiring and other methods of fixation [1]. However, several reports have described complications resulting from the use of K-wires. Botte et al. [2] reported a complication rate of 18%, including pin loosening, pin tract infection, and pin bending. Although they were easily resolved by removal of the pin without permanent sequelae, some authors have described life-threatening complications, such as, distant migration to a vital organ [3]. Until now, no case report has described K-wire breakage due to a manufacturing defect. We describe the breakage of a K-wire during removal resulting in a permanently retained remnant in the medullary cavity. A 15-year-old male was admitted to our hospital with right Hand swelling and pain. Plain radiography revealed an oblique Fracture in his right index metacarpal shaft with a dorsal apex angulation of 25 degrees. Under axillary block anesthesia, a tourniquet was applied to the upper arm at 250 mm Hg, and under fluoroscopic guidance, the Fractured index metacarpal was reduced using the Jahss maneuver. The metacarpophalangeal (MP) joint and the proximal interphalangeal (PIP) joint were flexed at 90 degrees and upward pressure was applied on the flexed finger to correct dorsal apex angulation. After reduction, two 1.1 mm thick K-wires were inserted from the sides of the second MP joint to the metacarpal base. The locations K-wires were checked using a fluoroscope, and the distal sharp ends were cut to leave a 1 cm length of wire (Fig. 1). To immobilize the Fractured segment, a short arm splint was applied. A week later, the short arm splint was removed and active range of motion was allowed. At 6 weeks postoperatively, radiologic union was achieved using plain radiography, and we attempted to extract the two K-wires. One of the K-wires was completely removed but the other broke at its mid-shaft (Fig. 2), leaving the remnant proximal portion buried in the medullary cavity (Fig. 3). Subsequently, the patient was able to flex and extend the MP joint fully and no symptoms such as pain, bleeding, or swelling were encountered. We noticed that the tip of the broken K-wire resembled the tip of the intact extracted wire. To determine the cause of the breakage, both K-wires were sent to the head office of the manufacturer (Solco Biomedical Co., Ltd., Pyeongtaek, Korea). We observed that the broken tip resembled the end of a normal K-wire tip in magnified view (40× magnification) (Fig. 4), signifying that the breakage was caused by a manufacturing defect. Fig. 1 A 15-year-old male had an oblique Fracture on the shaft of the right second metacarpal. A plain radiograph taken 4 weeks after surgery shows the two K-wires placed after reduction of the right index metacarpal. Fig. 2 The two extracted K-wires. The upper one is the broken K-wire and the lower one is the normal K-wire. Fig. 3 Plain radiograph obtained at 6 weeks postoperatively, showing the residual K-wire portion in the medullary cavity. Fig. 4 The tip of the broken K-wire was relatively sharp and had the same angle as the normal K-wire (40× magnified). K-wires are widely used for temporary fixation during Hand Fracture operations, and can be easily inserted and removed after bone union. K-wire fixation is a common and versatile method of achieving the internal fixation of Fractures in the Hand and wrist, and can be used to treat mallet finger and perform arthrodesis. Nevertheless, complications of K-wire fixation have often been reported [2]. These complications could be classified as Fracture-fixation-related or pin-related. The majority of Fracture-fixation complications involve pin loosening due to poor initial pin placement. Accurate reduction and pin insertion must be confirmed by intraoperative X-ray fluoroscopy, and if loosening is recognized, the pin should be removed to reduce the risk of complications, which include infection, migration, and nerve and tendon injury. Pin tract infections, which are the most common pin-related complications, can be treated by preventing motion, oral antibiotics, and pin removal [4]. Osteomyelitis is a major complication of K-wire fixation. Botte et al. [2] observed the development of osteomyelitis from a pin tract infection in 1% of patients. Pin migration from a shoulder or upper extremity to the heart or major vessels has already been described by Lyons and Rockwood [3]. They reported 49 cases of K-wire migration, which included 17 to major vascular structures and 8 deaths, and found that the migration of K-wires used to fixate the shoulder girdle was responsible. Tendon injury has been reported infrequently. Botte et al. [2] described two cases of FDP tendon entanglement. Neurological complications can also occur. Gosens and Bongers [5] reported a neurological problem rate of 16.5% among 200 patients. All recovered without sequelae, though one with persistent radial nerve palsy required a graft from the sural nerve. This report is the first to document K-wire breakage due to a manufacturing defect. It was difficult to identify the shaft defect responsible intraoperatively because the broken wire had an appearance similar to the normal wire. In fact, the defect was noticed only after pin removal and close examination of the broken tip. K-wires are used for various functions, but are not always safe. Complications are an unavoidable consequence of surgical procedures, and thus, it is important to recognize their causes and prevent repeat incidents. Our experience in the described case cautions that potential complications resulting from K-wire defects should be borne in mind.
