PubMed · 7897740
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A Combaliá, X Alemany. 1995. Elbow stabilization with a Kirschner wire.. https://doi.org/10.1097/00005373-199503000-00035
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For surgical treatment of the unstable Colles fracture we developed a new form of osteosynthesis, which consists in a modification of the dynamic Kirschner wire fixation described by Kapandji. It allows early motion without the typical risk of palmar dislocation noted with the Kapandji method. We prefer this method in elderly patients with reduced bone quality. The analysis of a collective of 110 fractures including a clinical and radiological follow-up examination of 72 patients revealed good anatomical reconstruction of the distal radius. The loss of motion was minimal on average and consistent with a good wrist function. Major restrictions resulted from stress-dependent pain as a consequence of posttraumatic arthritis or algodystrophy. A minor loss of reduction by dorsal impaction was observed in the follow-up evaluation, but it had no functional relevance. The most frequent complication was paraesthesia within the area of the superficial radial nerve. According to the NYOH score the following results were achieved: excellent 35%, good 50%, fair 10%, poor 5%.
Under the age of 11 years there are specific anatomic considerations which favour intramedullary wiring of displaced forearm fractures. The isthmus of radius and ulna is narrow (range = 3-6 mm). The medulla is at its widest proximally in the (ulna) and distally in the radius. These are the optimum entry points for intramedullary progression of the wire. At these points there is a low stress raising effect minimising the risk of iatrogenic fracture. A 1.6 mm Kirschner wire is elastic enough to be prebent into a large radius. It is strong enough to resist deformity on entry, though elastic enough to achieve stability by intramedullary three-point contact. The tip of the wire is prebent to 30 degrees aiding closed reduction of displaced fractures. An oblique 4.5 mm drill hole is made through a < 2 cm skin incision avoiding the epiphysis. This allows the wire to be introduced into the intramedullary canal at an optimum angle of 30 degrees. A smaller hole would not allow intramedullary progression e.g.; in a 2.5 mm hole the angle of insertion would be 55 degrees. Wire is now held with a cannulated T-handle, which is tapped with a hammer thus bouncing the wire of the side wall into the medulla. Rotating the handle aids reducing of displaced fractures. There are advantages to this method over other methods of intramedullary fixation e.g.; Steinman pins, Rush pins, or Nancy nails. Also holds advantage over plating. Over the last 12 months 11 cases were treated by the above methods without significant complications.
OBJECTIVE: Unstable median sternotomy closure can lead to postoperative morbidity. This study tests the hypothesis that separation of the sternotomy site occurs when physiologic forces act on the closure. METHODS: Median sternotomy was performed in 4 human cadavers (2 male) and closed with 7 interrupted stainless steel wires. The chest wall was instrumented to apply 4 types of distracting force: (1) lateral, (2) anterior-posterior, (3) rostral-caudal, and (4) a simulated Valsalva force. Forces were applied in each direction and were limited to physiologic levels (< 400 N). Four sets of sonomicrometry crystals were placed equidistantly along the sternum to measure separation at the closure site. RESULTS: Sternal separation occurred as a result of the wires cutting through the bone. Less force was needed to achieve 2.0-mm distraction in the lateral direction (220 +/- 40 N) than in the anterior-posterior (263 +/- 74 N) and rostral-caudal (325 +/- 30 N) directions. More separation occurred at the lower end of the sternum than the upper. During lateral distraction, xiphoid and manubrial displacement averaged 1.85 +/- 0.14 and 0.35 +/- 0.12 mm, respectively. Anterior-posterior distraction caused 1.99 +/- 0.04-mm xiphoid displacement and 0.26 +/- 0.12-mm manubrial displacement. During a simulated Valsalva force, more separation occurred in the lateral (2.14 +/- 0.11 mm) than in the anterior-posterior (0.46 +/- 0.29 mm) or rostral-caudal (0.25 +/- 0.15 mm) directions. CONCLUSIONS: These data suggest that sternal dehiscence can occur under physiologic loads and that improved sternal stability may be readily achieved via mechanical reinforcement near the xiphoid. Closure techniques designed to minimize wire migration into the sternum should also be developed.