PubMed · 9875820
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G M Actis Dato, L Deorsola, E Ruffini. 1998. Interlocking sternal closure.. https://doi.org/10.1016/s0003-4975(98)00831-5
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Undisplaced fractures of the proximal radius can generally be treated conservatively with good results. In children, spontaneous correction of some angular deformities can be expected during growth. Nevertheless, more severely displaced fracture types may require reduction in children, too. Open reduction and internal fracture fixation have shown to lead to a loss in range of motion frequently. A technique of percutaneous fracture reduction is demonstrated that can provide good results in cases when closed techniques have failed. A Kirschner wire is used to manipulate the fracture fragments percutaneously, which can often prevent open techniques. An additionally performed elastic-stable intramedullary nailing can add to an effective stabilisation and encourage to early physiotherapy.
The authors describe a patient who had Kirschner (K-) wire osteosynthesis of a right lateral clavicular fracture and developed a tetraparesis after 3 months. Plain X-ray and CT scan showed an intraspinal migration of one K-wire through the intervertebral foramen of C5/6. The K-wire was pulled out through an opening of the wound over the right clavicle. No CSF fistula was seen. The patient recovered without any postoperative neurological deficit. Patients with K-wire osteosynthesis should be informed about the risk of dislocation and wandering and should regularly be seen in the outpatient clinic. Regular X-rays should be performed. The K-wires must be sufficiently bent at the distal end to prevent wandering into the proximal direction. The K-wires should be removed soon after 6 weeks and, in cases of dislocation and migration, as early as possible.
The importance of using the centered lateral view of the knee for placement of tensioned wires during the treatment of periarticular fractures of the proximal tibia is illustrated. The technique of using a horizontal reference wire as a landmark for subsequent wire placement is described for circular fixators and hybrid fixators.