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Article
Evaluation of Functional Outcome after Open Reduction and Internal Fixation of Capitellar Fracture with K. Wires

Author: Adnan Husain Hnoosh
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 524-528
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUND :Isolated capitellar fractures are uncommon. Authors continue to differ about the preferred method of treatments and it's results on the post operative outcome.OBJECTIVE:Of This study: Is to evaluate the clinical and functional out come of operatively treated capitellar fracture with K.Wire , and furthermore to define the impact of fracture type on the out come.PATIENTS AND METHOD:A retrospective study carried out on 15 patients Sustaind closed capitellar fracture , 11 females , 4 males. The main age (16 – 58 years). the Operative treatment performed at a mean of 10 days, by open reduction through relatively limited lateral approach and internal fixation with k. wires. The evaluation of the functional outcome was by clinical and radiographic examination . The range of motion (ROM) by using of Mayo Elbow Performance Index (MEPI), and The American Shoulder and Elbow Surgeons (ASES) scales , and self assessment questionnaires form.RESULTS:Eight patients type I , one type II , four type III , two type IV ,and three patients had ipsilateral radial head fracture,. two in association with type III , and one with type IV. All fractures healed , with no significant clinical instability or weakness. The mean ulno-humeral motion (UHM) was (95o-132o) . All patients had full forearm rotation, average flexion contracture was 15o (range (8o-35o). (P=0.05). The mean (MEPI) was (90±10) points, with seven excellent results and six good , and the mean (ASES) was 36±3 (30 to 40 points) in seven patients. Ipsilateral radial head fracture had no significant effect on the functional outcome.CONCLUSION:Good to excellent outcome with functional ulnohumeral motion (UHM) can be achieved following open reduction and minimal fixation with k. wires in the treatment of capitellar fractures.


Article
External Fixation with Supplementary Intramedullary Kirschner Wires in the Treatment of Unstable Distal Radial Fractures
علاج كسر اسفل عظم الكعبره (غير المستقر) باستخدام جهاز التثبيت الخارجي المدعم بالكي واير

Author: Mohammed Jafer Jawad Al-Musawi محمد جعفر جواد الموسوي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 1 Pages: 85-92
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

AbstractBackground: External fixation is a popular method to reduce osseous deformity of the distal radius, but cannot assure maintenance of the reduction. Supplementing external fixation with intramedullary Kirschner wires can improve retention of fracture reduction during healing, resulting in better functional results.Objectives: To determine radiographic and functional outcomes in unstable distal radius fracture treated by close reduction and external fixation, with supplementary intramedullary Kirschner wires.Patients & methods: 26 distal radius fractures were treated with external fixation supplemented with intramedullary wires. The fractures were evaluated via good-quality posteroanterior and lateral radiographs. The radial height, radial inclination and volar tilting were measured on initial (preoperative) and immediate postoperative radiographs and on others taken immediately after the removal of external fixation. Overall results were based on objective radiographic and functional data as well as on subjective assessments with demerit-point scoring. Results: In our study ,we found that there is a great relationship between radiological restoration of the length of distal radius and functional outcome ,using the Dermerit point-rating system ,we found that 23 patients (89% ) had excellent or good result ,2 patients (8%) were classified as fair ,and 1 patients (3%) had poor results. Radial height, volar tilt of distal radius deformity and radial inclination improved significantly immediately after surgery, when external fixation was supplemented with intramedullary Kirschner wires. Clinical examination likewise found significantly better functional results regarding range of motions & grips strength.Conclusion: External fixation is a popular method to reduce osseous deformity of the distal radius, but cannot assure maintenance of the reduction. Supplementing external fixation with intramedullary Kirschner wires can improve retention of fracture reduction during healing, resulting in better functional results.Keywords: Unstable distal radius, external fixation, K-wires

الملخصالخلفيه البحثيه: استخدام جهاز التثبيت الخارجي المدعم بالكي واير لعلاج كسر عظم اسفل الكعبره (غير المستقر) والذي فيه تفت ظهري او زيحان كبير او امتداده لمفصل الرسغ من اجل الحصول على نتائج شعاعيه وسريريه جيده لايمكن الحصول عليها باستخدام طرق علاجيه اخرى الهدف: تقييم دور جهاز التثبيت الخارجي المدعم بالكي واير في علاج كسر اسفل عظم الكعبره (غير المستقر).طريقه العمل: استخدمت في هذه الدراسه 26 مريض في مستشفى اليرموك للفتره من كانون الاول 2009 لغايه اب 2011 وقد تراوحت اعمار المرضى مابين 52 للاناث و31 سنه للذكور وبمعدل 46 سنه وكان عدد مرضى الذكور 11 والاناث 15 وقد اجريت الفحوصات الشعاعيه لهم قبل العمليه وبعد العمليه مباشره وبعد رفع جهاز التثبيت الخارجي والداخلي وقد اعتمدت نتائج الدراسه على (حرزدرمت) لغرض معرفه النتائج النهائيه للمرضى النتائج: أظهرت الدراسة أن هناك علاقة كبيرة بين نتائج الفحوصات الشعاعية لأسترجاع الشكل الطبيعي لنهاية عظم الكعبرة والوظيفة الطبيعية له فيما يخص استرجاع حركة مفصل الرسخ وانقباض اليد, وبأستخدام حرز درمت أظهرت النتائج النهائية لـ (25) من المرضى المصابين بكسور غير مستقرة في أسفل عظم الكعبرة حيث كانت النتائج مرضية (جيد او ممتاز في 23 مريض) (89ٍ%) وكانت (مناسبه في 2مريض) (8%) وكانت (غير مناسبه في 1مريض) (3%) حيث تم استخدام جهاز التثبيت الخارجي المدعم بالكي واير لغرض التثبيت.الاستنتاج: استخدام جهاز التثبيت الخارجي المدعم بالكي واير يعطي نتائج جيده شعاعيا وسريرا وهي طريقه مناسبه للتقليل من التشوهات والاختلاطات التي تحدث لكسر اسفل عظم الكعبره (غير المستقر) نتيجه استخدام طرق علاجيه اخرى حيث ان دعم جهاز التثبيت الخارجي يساعد في تحسين وارجاع الكسر من غير مستقر الى مستقر والحفاظ عليه خلال فتره بناء الكسر وبالتالي يعطينا نتائج سريريه جيده


Article
Management Of Tibial Pilon Fractures With Spanning External Fixator Supported By K-Wires Fixation

Author: Zaid W. Al-Shahwanii زيد الشهواني
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2017 Volume: 16 Issue: 1 Pages: 63-73
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Pilon fractures of distal tibia result from axial load with high energy force That produce a spectrum of articular and metaphseal fractuers which are difficult to manage , especially when associated with soft tissue injuries with a high rate of complications when treated with primary open reduction & internal fixation, this drive the surgeon’s to use spanning external fixator & limited internal fixation like k-wirs as an alternative techique for definitive management.Patients & Method:Twenty cases of fractures of tibial pilon were collected; studied & treated in Al-Yarmook teaching hospital and Red Crescent surgical hospital during the period from October 2013 - october 2015..The average age of the patients were thirty five years (range from twenty tofifty years),16 cases were male, 4 cases were female.. 14 cases of them had associated fibular fracture . all are managed by Spanning External fixation with k-wires supplment as an internal fixation to hold the scattered pieces of articular surface .. Results: among those 20 cases there are 8 cases had a good results regarding ankle movement a good union with preservation of ankle mortise .While 9 cases had fair results due to either mal-union or limitation of ankle movements and only 3 casesended with poor results. There were only two cases complicated with infection (tibial osteomyelitis) (caseNo. 10 & No. 13) & were treated by proper antibiotics according to culture & sensitivity, also we had nine patients complain from pin tract infection which were treated by antibiotics and daily dressing.Discussion: The use of external fixation supported by k-wires to treat the metaphyseal portion of pilon (tibial plafond ) fractures with articular surface involvement has been reported to be associated with a lower rate of wound complications than open reduction & internal fixation.. and a good result of union .


Article
K. wire fixation versus conservative treatment of closed displaced intra-articular calcaneal fractures

Authors: Mohammed Sh. Al-Edanni (F.I.C.M.S. Ortho)*, --- Ako Faiq Kareem (F.I.C.M.S. Ortho)**, --- Shakir Hamad Zghair(F.I.C.M.S. Ortho)***
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2019 Volume: 15 Issue: 1 Pages: 86-94
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:Calcaneus is a spongy cancellous bone with rich blood supply , its fracture heals more rapidly providing no occurrence of infection and soft tissue injury around ,no gross malposition of fragments. The associated pain leads to a major impairment in life quality. The aim of treatment for calcaneal fractures is the decrease of pain and rebuilding of walking ability for patients with normal foot shape and the ability to wear normal foot wear. To reduce complications, a minimally invasive technique for the treatment of displaced intra-articular fractures of the calcaneus was preferred to use.The purpose of this study was to determine whether the closed reduction and percutaneous K. wire fixation of displaced intra-articular calcaneal fractures results in better functional outcome at a minimum one year follow up after the injury compared with those after non-operative management.Methods: One hundred and eleven displaced closed intra-articular calcaneal fracture in 105 patients (six were bilateral) were seen at the orthopedic department of Al-Kindy teaching hospital and Shaih Zaid hospital , only 45 cases included in this study and prospectively evaluated with an average follow-up time of minimum of one year (1–3years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Maryland Foot Score was used for clinical estimate. Sanders type II, III and IV fractures were diagnosed.Results: The incidence of subtalar arthritis was correlated with the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%.Discussion: Percutaneous K. wire fixation of displaced intra-articular calcaneal fractures presented minimally invasive technique which showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intra-articular, dislocated calcaneal fractures.Conclusions: the functional results after K. wires fixation of displaced intra-articular calcaneal fractures were better than those after non-operative care.

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