Kirschner Wire Breakage after Surgery of the Lesser Toes

1995 ◽  
Vol 16 (8) ◽  
pp. 504-509 ◽  
Author(s):  
Christopher Zingas ◽  
David A. Katcherian ◽  
Kent K. Wu
Keyword(s):  
Rheumatoid Arthritis ◽  
Kirschner Wire ◽  
Metatarsal Head ◽  
Wire Breakage ◽  
Point Of Entry ◽  
Forefoot Surgery ◽  
Postoperative Symptoms ◽  
K Wires ◽  
Rate Of Failure

A retrospective review was made of all patients operated on by the two senior authors from January 1985 to January 1993 for problems with Kirschner wire breakage following forefoot surgery. Thirty-three broken K-wires in 27 patients were encountered. All of these were 0.045-inch K-wires that had been placed across the metatarsophalangeal (MTP) joint of the lesser toes. In no case was there breakage of a K-wire that was larger than 0.045 inches or that did not cross the MTP joint. The medical records and radiographs of 565 consecutive patients having fixation with 0.045-inch K-wires that crossed the MTP joints of the lesser toes were then reviewed. A total of 1002 K-wires were used with an overall failure rate of 3.2% (4.8% of the patients). All of these K-wires failed just proximal to the point of entry into the metatarsal head. No intra-articular retained fragments were noted. Twenty-five of the retained fragments were completely within the metatarsal head and shaft, and eight of these fragments pierced the cortex of the metatarsal proximally. Twenty-three patients with retained fragments were examined in follow-up and in no case could the retained fragment be palpated or directly related to postoperative symptoms. Of the three patients who complained of persistent pain, two had mild pain with persistent MTP synovitis and one had severe pain due to lateral deviation of the toe after surgery. Patients with rheumatoid arthritis who underwent metatarsal head excision were noted to have a higher rate of failure (10.3% of patients, 4.0% of K-wires) than those without rheumatoid arthritis or metatarsal head excision (3.3% of patients, 2.3% of K-wires). Also four of the six cases with multiple K-wire breakage in the same foot had rheumatoid arthritis.

scholarly journals Rheumatoid forefoot reconstruction in the non-rheumatoid patient

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Devon Nixon ◽  
Richard McKean ◽  
Sandra Klein ◽  
Jeffrey Johnson ◽  
Jeremy J. McCormick
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Plane ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Rheumatoid Patient ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Forefoot Surgery ◽  
Forefoot Reconstruction

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Residual pain and recurrent deformity following forefoot surgery can cause significant disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resection – often referred to as a rheumatoid forefoot reconstruction – has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, has been published on outcomes of the same forefoot reconstruction operation in the non- rheumatoid patient. Here, we review our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery. Methods: Following chart review and surveying billing codes, we retrospectively identified patients from 2007-2015 without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resection (rheumatoid forefoot reconstruction). Phone surveys were then conducted to assess clinical outcomes including pain and satisfaction scores. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), 2nd MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were also assessed for radiographic union. Results: We identified 14 non-rheumatoid patients (16 feet) who underwent forefoot reconstruction – of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey. Mean postoperative follow up was 42.3 (range: 12-76) months from surgery to phone interview. Mean postoperative satisfaction scores were 9.1 (out of 10), and no patients required further surgery after forefoot reconstruction. Pain scores significantly decreased from 6.2 preoperatively to 2.0 postoperatively (P<.001). Radiographic parameters (IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) all improved with surgery (P<.05). All 16 feet achieved union of the first MTP arthrodesis. Conclusion: With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with metatarsal head resection (rheumatoid forefoot reconstruction) is a viable surgical option for non-rheumatoid patients who have failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity.

Rheumatoid Forefoot Reconstruction in the Nonrheumatoid Patient

2017 ◽  
Vol 38 (6) ◽  
pp. 605-611 ◽  
Author(s):  
Devon C. Nixon ◽  
Richard M. McKean ◽  
Sandra E. Klein ◽  
Jeffrey E. Johnson ◽  
Jeremy J. McCormick
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Plane ◽  
Case Series ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Recurrent Pain ◽  
Radiographic Parameters ◽  
Forefoot Surgery ◽  
Forefoot Reconstruction

Background: Recurrent pain and deformity following forefoot surgery can cause significant patient disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resections—termed the rheumatoid forefoot reconstruction—has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, have been published on outcomes of the same forefoot reconstruction operation in the nonrheumatoid patient. Here, we describe our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery. Methods: Following chart review and reviewing billing codes, we retrospectively identified patients without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resections. Phone surveys were conducted to assess clinical outcomes including pain and patient satisfaction. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), second MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were assessed for radiographic union. We identified 14 nonrheumatoid patients (16 feet) who underwent forefoot reconstruction. Of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey at an average of 44.3 months postoperatively (range: 20-76 months). Results: Mean postoperative satisfaction scores were 9.0 (out of 10). No patients required reoperation at final phone follow-up. Pain scores significantly decreased from 6.2 preoperatively to 1.9 postoperatively ( P <.001). Radiographic parameters (1,2 IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) improved with surgery ( P <.05), and all 16 feet achieved union of the first MTP arthrodesis. Conclusion: With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with lesser metatarsal head resection was a viable option for nonrheumatoid patients who failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity. Level of Evidence: Level IV, retrospective case series.

scholarly journals Kirschner Wire Breakage during Removal Requiring Retrieval

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Kai Yuen Wong ◽  
Rosalind Mole ◽  
Patrick Gillespie
Keyword(s):  
Hand Function ◽  
Kirschner Wire ◽  
Cost Effective ◽  
Middle Finger ◽  
Complication Rates ◽  
Simple Method ◽  
Wire Breakage ◽  
Wire Fixation ◽  
Pin Site ◽  
K Wires

Kirschner wires (K-wires) are widely used for fixation of fractures and dislocations in the hand as they are readily available, reliable, and cost-effective. Complication rates of up to 18% have been reported. However, K-wire breakage during removal is rare. We present one such case illustrating a simple technique for retrieval. A 35-year-old male presented with a distal phalanx fracture of his right middle finger. This open fracture was treated with K-wire fixation. Postoperatively, he developed a pin site infection with associated finger swelling. The K-wire broke during removal with the proximal piece completely retained in his middle phalanx. To minimise risk of osteomyelitis, the K-wire was removed with a novel surgical technique. He had full return of hand function. Intraoperative K-wire breakage has a reported rate of 0.1%. In our case, there was no obvious cause of breakage and the patient denied postoperative trauma. On the other hand, pin site infections are much more common with reported rates of up to 7% in the hand or wrist. K-wire fixation is a simple method for bony stabilisation but can be a demanding procedure with complications often overlooked. It is important to be aware of the potential sequelae.

Surgery of the Forepart of the Foot in Rheumatoid Arthritis

Foot & Ankle ◽  
1982 ◽  
Vol 3 (3) ◽  
pp. 173-180 ◽  
Author(s):  
Nathaniel Gould
Keyword(s):  
Rheumatoid Arthritis ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Great Toe ◽  
Extensor Tendons ◽  
Lateral Drift ◽  
First Metatarsal ◽  
The Past ◽  
Silastic Implant

The purpose of this paper is to introduce a surgical approach to treatment of severe forefoot deformities of rheumatoid arthritis. Briefly, the surgery consists of base of the first metatarsal osteotomy to correct metatarsus primus varus, and metatarsal head resection beginning with the fifth metatarsal and carried around in crescentic fashion through the necks of the other metatarsals, so that as an end result the great toe is the longest, the second next to the longest, etc. The short extensor tendons are dissected to their insertions and, since they have drifted laterally into the “valleys” pulling the toes into lateral drift with them, they are usually sacrificed. The long extensor tendons are appropriately lengthened to proper tension. All the toes are straightened by plantar capsulotomies, dermotomies, and long flexor tenotomies, and the toes held straight with C-.045 wire in shishkabob fashion. Then, under direct vision, each wire is drilled up into the metatarsal shaft, aligning the toes into parallel cosmetic fashion. In the early cases, a single stem silastic implant was utilized but for the past 5 years now the double stem silastic implant is employed for the first MTP joint and is inserted “upside down” in order to give its greater power towards the floor. A cast is not used, but the patient ambulates on a well-padded bandaged foot by the second or third day. Twenty patients (40 feet) were operated upon (17 females and 3 males, ages 28 to 72 years, average 47 years), with a follow-up of 3 to 5 years. Pain relief has been remarkable. Good great toe function has been obtained in all cases with excellent power to the floor and a satisfactory range of dorsiflexion ability. About 67% have developed some mild recurrence of hallux valgus, but none so severe that it has been disabling. All patients have been pleased with their final results.

Great Toe Metatarsophalangeal Joint Arthrodesis: A User-Friendly Technique

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 367-377 ◽  
Author(s):  
Ronald W. Smith ◽  
Terry L. Joanis ◽  
Phyllis D. Maxwell
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
First Metatarsal ◽  
Pin Fixation ◽  
Patient Responses ◽  
K Wires ◽  
User Friendly

Thirty-four feet (23 patients) were treated with a metatarsophalangeal (MP) joint fusion of the hallux using five threaded 0.062-in K wires for fixation. Operations were done for the following diagnoses: rheumatoid arthritis (26 procedures), hallux rigidus (1), salvage of previous bunionectomies (3), hallux valgus with absent toe, bilateral fusion (2), severe hallux valgus with chronic MP joint synovitis (1), and congenital hallux varus (1). The ages ranged from 17 to 73 years, with an average of 55 years. Follow-up was available on 31 of the fusions by questionnaire and telephone contact, with an average follow-up of 24 months and a minimum of 1 year. The successful arthrodesis rate was 97%. In 9% of the procedures (three cases), the patients were dissatisfied: This was due to pain under the first metatarsal head in two cases and to impingement between the first and second toes in a third case. In 91% of the fusions (29 of 32 patient responses), the patients stated that they would have the surgery if they had to choose again. Patients indicated “complete satisfaction” in 15 fusions and “satisfaction with reservations” in 14. Patients felt that their ability to wear desired shoes was improved in 48% of the procedures, was unchanged by the fusions in 26%, and was worse than before the operation in 26%. Based on this study and review of the literature, a recommendation is made for fusing the rheumatoid hallux with 25° to 30° of valgus and 10° of extension. In general, selection of toe position for fusion is based on reducing stress on the hallux interphalangeal joint and accommodating the position of the second toe. The multiple pin fixation technique gives a high incidence of fusion, it is easy to perform, and it is adaptable to the varying requirements for toe position.

scholarly journals Two Weeks of Kirschner Wire Fixation following Chevron Osteotomy for Hallux Valgus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0041
Author(s):  
Ryan G. Rogero ◽  
Daniel Corr ◽  
Joseph T. O’Neil ◽  
Steven M. Raikin
Keyword(s):  
Hallux Valgus ◽  
Kirschner Wire ◽  
Valgus Deformity ◽  
Time Points ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Postoperative Time ◽  
The Mean ◽  
K Wires

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Distal 1st metatarsal chevron osteotomy is one of the most frequently performed procedures for treatment of mild to moderate hallux valgus, though the optimal method of fixation remains in question. The use of Kirschner wires (K-wires) is an established technique of temporary internal fixation that offers a simple and cost-effective strategy. Previous studies have reported removal of K-wires ranging from 4-8 weeks following a chevron osteotomy, though even earlier removal may be acceptable and serve to decrease the risk of complications. The purpose of this study was to determine if early removal of K-wires is adequate to maintain correction of a hallux valgus deformity following distal 1st metatarsal chevron osteotomy. Methods: We conducted a retrospective review of patients who had their 1st metatarsal K-wire removed at their first (2week) postoperative visit after undergoing primary chevron osteotomy for treatment of a hallux valgus deformity with a single foot and ankle fellowship-trained orthopaedic surgeon from 2010-2018. Exclusion criteria consisted of revision osteotomies, K-wire removal >=21 days postoperatively, concomitant midfoot or hindfoot procedures, and lack of preoperative or at least 3-month postoperative radiographs. Preoperative, 6-week, 3-month, and longer-term intermetatarsal angles (IMA) were measured on weightbearing anteroposterior (AP) radiographs by an individual blinded to and not involved in the care of the patients. The pre- and postoperative tibial sesamoid position according to the Hardy and Clapham classification (grades 1-7) was also recorded on those with longer-term AP radiographs on file. From 2010-2018, 275 patients underwent 295 primary chevron osteotomies by the senior author, with 72 osteotomies (24.4%) excluded, leaving 223 (75.6%) available for analysis. Results: Patients had a mean preoperative IMA of 11.4 +- 2.0 degrees. At 6 weeks, 3 months, and longer-term follow-up averaging 24.6 months, patients had mean IMA of 3.8 +- 1.7, 4.6 +- 1.7, and 4.6 +- 2.2 degrees, respectively, all of which were significantly less (P<0.0001) than the mean preoperative IMA. Of those with longer-term follow-up (n=56, 25.1%), the tibial sesamoid position decreased from 4.6 +- 0.8 preoperatively to 2.3 +- 0.7 at 6 weeks, 2.4 +- 0.8 at 3 months, and 2.6 +- 0.9 at final follow-up. All 3 postoperative time points of tibial sesamoid positions were significantly less (P<0.0001) than the mean preoperative position. Conclusion: Our findings demonstrate that removal of K-wires less than 3 weeks following a distal 1st metatarsal chevron osteotomy is sufficient to maintain correction of hallux valgus deformity. The loss of correction in this study is in line with previous studies, where K-wires were removed at later postoperative time points. Delayed wire removal has been shown to lead to increased complications, such as pin tract infection and bending or breakage of the K-wire, which can require not only additional office visits but also potential revision procedures. Removing the K-wire in the early postoperative period should be considered effective and safe.

scholarly journals Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures

2021 ◽  
Vol 32 (2) ◽  
pp. 397-405
Author(s):  
Mehmet Baydar ◽  
Abdurrahman Aydın ◽  
Ayşe Şencan ◽  
Osman Orman ◽  
Serkan Aykut ◽  
...  
Keyword(s):  
Grip Strength ◽  
Kirschner Wire ◽  
Operation Time ◽  
Wound Complications ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Wire Fixation ◽  
K Wires ◽  
Surgery Duration

Objectives: In this study, we aimed to compare clinical and radiographic outcomes of retrograde intramedullary Kirschner-wire (K-wire) fixation with those of plate-screw (PS) fixation. Patients and methods: A total of 98 metacarpal shaft fractures in 75 patients (65 males, 10 females; mean age: 31.2±10.9 years; range, 16 to 65 years) were included between January 2011 and December 2017. The total joint active range of motion (AROM) and grip strength of the healthy and broken hands were evaluated. The Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded. We compared surgery duration, number of fluoroscopy images, and cost-effectiveness for each technique. Results: The overall mean follow-up was 21.9 (range, 12 to 56) months. At the last follow-up, total joint AROM (p=0.072), VAS score (p=0.298), QuickDASH score (p=0.132), and hand grip strength (p=0.947) were similar between the groups. Radiological union occurred in the PS and K-wire groups in a mean of 5.84 (range, 3 to 8) and 4.46 (range, 3 to 20) weeks, respectively (p=0.173). A significant difference was found in surgery duration (p=0.021) and number of fluoroscopy images (p<0.05) between the PS and K-wire groups. Two wound complications were observed in the PS group and one with K-wires. Conclusion: Retrograde intramedullary K-wire fixation has certain advantages such as being less invasive and more accessible with shorter operation time, compared to PS fixation. Similar radiological and clinical scores can be obtained in patients undergoing retrograde intramedullary K-wire fixation or PS fixation.

scholarly journals UNSTABLE FRACTURE OF RADIUS AND ULNA

2011 ◽  
Vol 18 (02) ◽  
pp. 323-327
Author(s):  
WAQAR ALAM ◽  
FAAIZ ALI SHAH ◽  
ZAFAR DURRANI ◽  
Zahid Askar ◽  
Muhammad Ayaz Khan ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Unstable Fracture ◽  
Fractures In Children ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Ulna Fractures ◽  
K Wires ◽  
Age Range ◽  
Radiological Union

Objectives: To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Study Design: Descriptive study. Period: 27/03/2009 to 26/03/2010. Setting: Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. Patients and Methods: All patients were admitted from OPD . Children less than 16 years with Unstable Radius- Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. Results: A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Conclusions: Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures.

Plantar Pressure Distribution After Resection of the Metatarsal Heads in Rheumatoid Arthritis

1997 ◽  
Vol 18 (7) ◽  
pp. 391-397 ◽  
Author(s):  
Peter Bitzan ◽  
Alexander Giurea ◽  
Axel Wanivenhaus
Keyword(s):  
Rheumatoid Arthritis ◽  
Load Distribution ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Resection Arthroplasty ◽  
First Metatarsophalangeal Joint ◽  
Plantar Pressure Distribution ◽  
Variable Extent ◽  
Reduction Of Pain

Surgical correction of the forefoot in rheumatoid arthritis by resection of all metatarsal heads in combination with a resection arthroplasty of the first metatarsophalangeal joint showed excellent and good results in 20 (77%) of 26 cases and satisfactory and fair results in 6 (23%) of 26 cases. Twenty-six feet in 16 patients were operated on by a plantar approach and examined after a mean follow-up period of 50 months (range, 24–90 months). Seventy-three percent of the patients were free of pain. In 75 (58%) of all 130 investigated toes, complete absence of load distribution was noted. In the remaining 55 (42%) toes, we observed a variable extent of function, depending on the length of resection. Although toe function is better in minimal metatarsal resection, single excessive length or plantar spike formation revealed pressure peaks in the metatarsal area. Metatarsal head resection provided reduction of pain and correction of severe deformities, and permitted the patients to wear ordinary shoes in 24 (93%) of 26 cases.

Parallel K-Wire Placement Leads to Fusion and Midcarpal Settling in Scaphoid Excision Four-Corner Fusion

Hand ◽  
2021 ◽  
pp. 155894472110573
Author(s):  
Dann Laudermilch ◽  
Alejandro Morales-Restrepo ◽  
Sumail Bhogal ◽  
Robert A. Kaufmann
Keyword(s):  
Patient Outcomes ◽  
Rating Scale ◽  
Dynamic Compression ◽  
Kirschner Wire ◽  
Good Patient ◽  
Patient Reported ◽  
The Mean ◽  
K Wires

Background: Scaphoid excision 4-corner fusion is a motion-sparing procedure in patients with advanced radioscaphoid arthritis. This study introduces an alternate technique for scaphoid excision 4-corner fusion using a parallel Kirschner wire (K-wire) construct across the midcarpal joints that leads to reliable fusion rates, and good patient outcomes. Methods: This is a single-surgeon, retrospective study of patients who underwent scaphoid excision 4-corner fusion, using a parallel K-wire construct across the midcarpal joints. Once fusion was achieved, K-wires were removed. Radiographic union rate, time to union, capitolunate angle, capitolunate coverage, and amount of midcarpal settling are measured. Patient-reported outcome measures and descriptive statistics are presented. Results: Sixty-five wrists were included in this study with a mean age of 50.1 years. One patient was lost to follow-up. All 64 wrists (100%) fused at an average of 2.6 months. The mean capitolunate angle was 7°, and capitolunate coverage was 99.2%. Fifty-two patients (81%) had adequate radiographs for measurement. Average midcarpal settling was 1.1 mm. Thirty-two patients (51%) were available for long-term follow-up at an average of 5.3 years (0.7-10.2 years), and participated in patient reported outcomes (PRO) surveys. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 16.6, and numeric pain rating scale score was 1.8. Conclusions: Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. Midcarpal settling that occurs through dynamic compression around the K-wires may have contributed to bony fusion. This technique may provide an alternative approach to achieving reliable fusion across the midcarpal joints.

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