Complications of Smooth Pin Fixation of Fractures and Dislocations in the Hand and Wrist

Botte, Michael J.; Davis, James; Rose, B; Schroeder, Herbert P. von; Gellman, Harris; Zinberg, Ephraim M.; Abrams, Reid A.

doi:10.1097/00003086-199203000-00025

Cited by 132 publications

(115 citation statements)

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“…29,39 In a study of 314 patients with distal radial fractures treated with external fixation, 21% developed a pintract infection. 40 The present study found a much lower rate with only 2/59 (3%) of the external fixation patients developing an infection. There were no infections in the volar plating group.…”

Section: Discussioncontrasting

confidence: 51%

Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

Wartinbee¹,

Miller²,

Riboh³

2011

The Duke Orthopaedic Journal

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Section: Discussioncontrasting

confidence: 51%

Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

Wartinbee¹,

Miller²,

Riboh³

2011

The Duke Orthopaedic Journal

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“…Complication rates in few of the previously published relevant studies such as Stahl and Schwartz (15.2%), 22 Botte et al (18%) 23 and Stern and Fulton (42%) 24 are all related to adult patients and studying hand and wrist region. Leet et al 20 observed 30 patients (18.98%) with unsatisfactory results in a review of 158 type 3 supracondylar humerus fractures.…”

Section: Discussionmentioning

confidence: 96%

“…Cheng et al 17 analysed 403 cases of supracondylar fracture of the humerus in children. They found two cases of superficial pin tract 23 observed infections in 10 patients (7%) and pin loosening without infection in 6 (4%) out of 137 patients. Leet et al 20 presented a retrospective review of 158 type 3 supracondylar humerus fractures.…”

Section: Wound-related Complicationsmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17][18][19][20][21] Stahl and Schwartz 22 reported 15.2%, Botte et al 23 found 18%, and Stern and Fulton 24 reported 42% complication rates with K-wiring procedure, but these were confined to the hand and wrist region and related to adult patients. There are no studies specifically examining the complication rate associated with use of Kwires in fracture fixation in children regardless of their specific anatomical location.…”

mentioning

confidence: 99%

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A Review of K-wire Related Complications in the Emergency Management of Paediatric Upper Extremity Trauma

Sharma

Taylor

Clarke

2007

annals

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INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically.PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). Wound-related complications included over-granulation in 13 cases, pin tract infection in 6 cases and hypersensitive scar in 1 case. Neurapraxia was found in 3 patients and axonotmesis in 1 patient. Wire loosening at the time of removal in 14 cases and retrograde wire migration in 4 cases were observed. There were 2 cases of penetrating tendonitis and 1 case of osteomyelitis. There was a higher complication rate in terms of wire loosening and pin tract infection when the K-wires: (i) were left outside the skin compared with those placed under the skin; (ii) stayed longer in the patients; and (iii) did not traverse both cortices. There were more complications in complex operations performed by senior surgeons (P = 0.056). The duration of K-wire stay, associated co-morbidity and anatomical location were statistically insignificant.CONCLUSIONS Complications are part of operative procedures; an important point to consider is what causes them in order to take preventative measures. We recommend that the risks and complications should be explained to parents during the consenting process to allay their anxiety, irrespective of the fact that most complications are minor and of short duration.

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“…Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27)(28)(29)(30)(31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss.…”

mentioning

confidence: 99%

Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

Macdonald¹,

Higgins²,

Kean³

et al. 2014

CAN J PLAST SURG

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Metacarpal fractures are among the more common fractures of the upper extremity (1-7), accounting for 18% of all below-elbow fractures in the United States (5). Freehan and Sheps (8) reported that metacarpal fractures represented 42% of 72,481 reviewed cases of hand fractures. Spiral metacarpal fractures commonly result in some shortening of the metacarpal shaft (9), which may subsequently cause extension lag at the metacarpophalangeal (MCP) joint and reduced grip strength (9-13). Several studies have documented the relationship between shortening and hand function (1,9,12,(14)(15)(16)(17)(18)(19)(20)(21), although the maximum amount of shortening that occurs following metacarpal fracture and acceptable limits appear to be controversial.Historically, spiral fractures occurring without scissoring have been treated surgically to restore metacarpal length and prevent these losses in power and function. Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss. Furthermore, one must consider the cost, complications and consequences associated with surgery, postoperative management and wound healing.Increasingly, conservative management of nonscissoring spiral metacarpal fractures has come into favour in the absence of absolute indications for a surgical approach (10,11,16,32). Despite potential shortening of the metacarpal, a nonoperative approach preserves the integrity of the intrinsic muscles of the hand, thereby benefiting functional recovery, while also avoiding the aforementioned consequences and costs of surgery. Unfortunately, however, few studies exist documenting the long-term natural history of unoperated spiral metacarpal fractures. The purpose of the present study was, therefore, to investigate this outcome.We conducted a prospective consecutive case series of unoperated, nonscissoring spiral metacarpal fractures to document the effect of conservative management on resultant power in the hand despite the metacarpal shortening that is often associated with these fractures. BACKgROUND: Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand. OBJECTIVE: To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures. METHODS: Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural histor...

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Complications of Smooth Pin Fixation of Fractures and Dislocations in the Hand and Wrist

Cited by 132 publications

References 0 publications

Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

Comparative Analysis of the Complication Profile following Palmar Plating versus External Fixation of Fractures of the Distal Radius

A Review of K-wire Related Complications in the Emergency Management of Paediatric Upper Extremity Trauma

Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

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