Lisfranc injuries make up 0.2% of all fractures. With or without midfoot injuries, treatment requires early accurate diagnosis, anatomical reduction and stable internal fixation. Some surgeons prefer K-wire fixation, while others rely on rigid screw fixation, especially of the medial column. To assess the radiological and functional outcome of K-wire fixation of Lisfranc injuries, we carried out a prospective study between January 1999 and December 2000. The ages of our 15 male and four female patients ranged from 15 to 47 years. Using the Quenu and Kuss system to classify injuries, we treated five isolated, nine homolateral and five divergent injuries. In eight patients there were associated midfoot injuries, and four had compound fractures. We treated 11 fractures with closed reduction and K-wires. Open reduction with K-wire fixation was carried out on eight fractures, including the four compound fractures, within 19 days of admission. All patients were kept non-weight-bearing in a short backslab, and the wires removed at six weeks. Follow-up times ranged from 4 to 19 months. To assess functional outcome we used the American Orthopaedic Foot and Ankle Society’s midfoot scoring system, which has a maximum score of 100. The mean score of our patients was 70 (52 to 85). Mild or occasional foot pain and slight gait abnormality resulted in limitation of recreational activities. At three months, 15 patients were fully weight-bearing. A single case of superficial sepsis resolved, and there were no cases of implant failure or loss of reduction. K-wire fixation following anatomical reduction is a satisfactory option for the treatment of tarsometatarsal injuries, especially when severe injuries involve the midfoot. The technique is minimally invasive and the K-wires are easily inserted and removed

Background. Percutaneous K-wire fixation is a well-recognised and often performed method of stabilisation for distal radius fractures. However, there is paucity in the literature regarding the infection rate after percutaneous K-wire fixation for distal radius fractures. Aims. To analyse the rate and severity of infection after percutaneous K-wire fixation for distal radius fractures. Material and methods. Between October 2004 and June 2005, 43 patients with closed distal radius fractures had percutaneous K-wire fixation. The wires were left outside the skin in all the cases for easy removal at the end of six weeks at the clinic. They were followed up in the clinic at 1, 2, 4, and 6 weeks. The pin tracts were examined at 2 weeks and six weeks, or if needed earlier. The severity of pin tract infection was graded using modified Oppenheim classification. Results. Out of 43 patients, the male to female ratio was 13:30. The mean age was 49.1 years (range 5-86 years). There were nine cases of pin tract infection, out of which three were grade I, three were grade II, two were grade III, and one was grade IV. In three cases the K-wires had to be removed earlier. Discussion. The infection rate after percutaneous K-wire fixation for distal radius fractures is high (20.9%), which is equivalent to the infection rate quoted in the literature for hybrid external fixators. As the K-wires are used to fix the fractures, the expected implant infection rate in Trauma and Orthopaedics which is less than 1% should be aimed for. However this is not the case. Hence, burying the K-wires under the skin may be an alternative to reduce the infection rate after percutaneous K-wire fixation of distal radius

Purpose: This study compares clinical and radiological outcomes of K-wire fixation with volar locking plate (i.e. fixed angle) fixation in unstable, dorsally angulated, distal radius fractures. Materials and methodology: Fifty four adult patients with an isolated, closed, unstable, dorsally angulated fracture without articular comminution were randomised to closed reduction and K-wire fixation (3 wires) or volar locking plate fixation. All were immobilised in a cast for six weeks and prescribed physiotherapy. Independent clinical and radiological assessment was performed at 3 and 6 months post injury, using the DASH and Gartland & Werley scoring systems. Results: Twenty-four patients were treated with a plate and thirty with K-wires. There were no complications in the plate group. There were 9 complications in the K-wire group. Three patients required re-operation (for malunion, median nerve compression, and retrieval of a migrated wire). Remaining complications included: 5 pin-site infections and 1 superficial radial nerve palsy. Plate fixation achieved statistically significant better radiological and functional results. Conclusion: Volar locking plate fixation achieves better radiological and functional results with fewer complications than K-wire fixation in unstable, dorsally angulated, distal radius fractures

This study aims to compare the outcomes of Volar locking plating (VLP) versus percutaneous Kirschner wires (K-wire) fixation for surgical management of distal radius fractures. We systematically searched multiple databases, including MEDLINE for randomized controlled trials (RCTs) comparing outcomes of VLP fixation and K-wire for treatment of distal radius fracture in adults. The methodological quality of each study was assessed by the Cochrane Risk of Bias tool. Patient-reported outcomes, functional outcomes, and complications at 1 year follow up were evaluated. Meta-analysis was performed using random-effects models and results presented as risk ratios (RRs) or mean differences (MDs) with 95% confidence interval (CI). 13 RCTs with 1336 participants met the inclusion criteria. Disabilities of the Arm, Shoulder and Hand (DASH) scores were significantly better for VLP fixation (MD= 2.15; 95% CI, 0.56-3.74; P = 0.01; I2=23%). No significant difference between the two procedures for grip strength measured in kilograms (MD= −3.84; 95% CI,-8.42-0.74; P = 0.10; I2=52%) and Patient-Rated Wrist Evaluation (PRWE) scores (MD= −0.06; 95% CI,-0.87-0.75; P = 0.89; I2=0%). K-wire treatment yielded significantly improved extension (MD= −4.30; P=0.04) but with no differences in flexion, pronation, supination, and radial deviation (P >0.05). The risk of complications and rate of reoperation were similar for the two procedures (P >0.05). This meta-analysis suggests that VLP fixation improves DASH score at 12 months follow up, however, the difference is small and unlikely to be clinically important. Existing literature does not provide sufficient evidence to demonstrate the superiority of either VLP or K-wire treatment in terms of patient-reported outcomes, functional outcomes, and complications

Aim: We report radiological outcome following percutaneous minimally invasive corrention of Hallux Valgus using K-wire fixation. Methods: We followed 15 patients (11 bilateral operations) who had above procedure for Hallux Valgus deformity correction. All patients had pre operative and post operative x-rays assessed for Hallux Valgus angle, 1st Intermetatarsal angle and Distal Metatarsal Articular angle. We also collected clinical data including deformity correction and complications. Results: Mean age of the patients was 55.47(SD 14.27). Of the 15 procedures 11 had bilateral operations and 4 had only one side operated (total 14 right sided 12 left sided operations). Mean duration of follow up was 85.47 days (range 29 to 259). The pre operative mean Hallux Valgus angle was 37.05(SD 6.49, range 28 to 49) where as post operative it was 11.32(SD 9.07, range 0 to 33). The pre operative mean 1st Intermetatarsal angle was 16.46(SD 2.74, range 11 to 21) where as post operative it was 5.48(SD 3.62, range 1 to 16). The pre operative mean Distal metatarsal articular angle was 35.36(SD 8.38, range 18 to 51) where as post operative it was 8.29(SD 9.13, range 0 to 38). Clinically one great toe had infection post operatively requiring early removal of K-wires resulting in residual deformity. One had mild bilateral recurrence, two had mild unilateral recurrence. These patients did not require any further surgery. Conclusion: Above results indicate that Percutaneous Minimally invasive Hallux Valgus correction using K-wire fixation showed good radiological correction in various angles measured to quantify Hallux Valgus deformity

The aim of this study is to compare functional, clinical and radiological outcomes in K-wire fixation versus volar fixed-angle plate fixation in unstable, dorsally angulated distal radius fractures. Fifty-four adult patients with an isolated closed, unilateral, unstable, distal radius fracture were recruited to participate in the study. Only dorsally displaced fractures with no articular comminution were included. Patients were randomised to have their fracture treated with either closed reduction and K-wire fixation (3 wires) or fixed-angle volar plating. Both groups were immobilised in a below elbow cast for six weeks. The wires removed in the outpatients at six weeks and both groups were referred for physiotherapy. Independent clinical review was performed at three and six months post injury. Functional scoring was performed using the DASH and Gartland and Werley scoring systems. Radiographs were evaluated by an independent orthopaedic surgeon. Twenty-five patients were treated with a plate and twenty-nine with wires. There were no complications in the plate group. There were 9 complications in the K-wire group with 3 patients requiring a second operation (1 corrective osteotomy for malunion, 1 median nerve decompression and 1 retrieval of a migrated wire). The remaining complications included: 5 pin site infections (3 treated with early pin removal and 2 with oral antibiotics only), and 1 superficial radial nerve palsy. There were no tendon ruptures. Both groups scored satisfactory functional results with no statistical difference. There was a statistically significant difference in the radiological outcomes with the plate group achieving better results. We conclude that in unstable dorsally angulated distal radius fractures volar fixed-angle plate fixation is able to achieve comparable functional results to K-wire fixation with better radiological results and fewer complications. This has resulted in a change in our clinical practice

Conservative treatment of the ‘boxer’s fracture’ gives acceptable functional results but often leaves the patient with a residual deformity.

Using a prograde intramedullary K-wire, we treated 23 consecutive patients with a fractured neck of the fifth metacarpal. Volar angulation exceeded 40°. A 1.6-mm pre-bent K-wire was inserted via the base of the fifth metacarpal in each case. Time to regaining full function, time to union and final functional and radiological outcome were recorded.

All 23 patients went on to full clinical and radiological union within six weeks. In 18 patients, the reduction was anatomical with no residual angulation. In five the residual angulation ranged from 5° to 15°, with a mean of 8°. There was a transient sensory neuropraxia in two patients.

This minimally invasive technique is a simple, cost-effective and reliable method of treating a ‘boxer’s fracture’ and ensures a rapid return to full function with little or no residual deformity.

Mitchell – Hawkins osteotomy is a widely used technique for correction of mild to moderate hallux valgus. Several authors have recognised that, for a good result, the osteotomy must be stable enough to prevent excessive shortening or displacement of the distal fragment. Several fixation techniques have been proposed: sutures, staples, K-wires and screws. The aim of the study is to define whether the use of a screw could give better results than a single K-wire in the fixation of the osteotomy. We studied prospectively 30 patients with moderate hallux valgus operated on consecutively at our institute using the Mitchell osteotomy. In 15 patients (Group A) fixation was achieved with a single K-wire inserted through the tip of the toe and driven medial to the metatarsal head into the first metatarsal shaft, while in the others (Group B) a Herbert screw was used. All procedures were identical except for the fixation device and were carried out by the same surgeon. Weight bearing was allowed from the first day after surgery with a postoperative shoe. The K-wire was removed at the fifth postoperative week. In Group B the correct position of the great toe was maintained with a dressing, renewed weekly for 8 weeks after surgery. Patients were evaluated clinically with the AOFAS score and radiologically either before surgery and at the follow-up. The mean follow-up time was 10 months. We did not find any difference between the groups in correction of the intermetatarsal angle and of the valgus angle or in the improvement of the AOFAS score. No symptomatic displacement of the distal fragment occurred in either group. Five patients of Group A complained of a pin tract infection of the K-wire, which was treated successfully with oral antibiotics. No deep infection occurred. All the patients were satisfied with the treatment received but the majority of those of Group A (10/15) complained of discomfort in leaving the K-wire in place for such a long time. The Mitchell – Hawkins osteotomy can be fixed either with a K-wire or a screw with similar results in terms of angle correction and clinical scores. Patients felt more comfortable without protruding fixation devices, but for a successful procedure with the use of a screw, repeated dressing of the foot is required, which is time-consuming for both the surgeon and the patient.

To ascertain the optimum number, thickness and configuration of K-wires needed to prevent displacement of distal radial fractures.

Synthetic and cadaver bones were used. A transverse osteotomy was performed 1. 5 cm proximal to the articular surface of the distal radius. Different numbers and configurations of 1. 1mm or 1. 6mm K-wires were used to hold the bone reduced. Dorsoradial and distraction forces were applied using a tensiometer. The endpoint was a displacement of 3mm at the osteotomy site.

We demonstrated a statistically significant increase in the force required to displace the osteotomy site a) when using thicker wires and b) when using three crossed wires compared with two wires either crossed or parallel.

When balancing ease of insertion with maximum stability, we would recommend two parallel 1. 6mm wires inserted through the radial styloid process, with 1 wire inserted from the dorsoulnar corner of the radius crossing at approximately 90 degrees. All wires should pass into the opposite cortex. This configuration resisted forces of over 300 Newtons and there was little benefit in using additional wires.

The use of percutaneous Kirschner wires [K-wires] and plaster is a popular method of treatment for displaced distal radius fracture. However, multi-database electronic literature review reveals unsurprisingly different views regarding their use.

From August 2002 till June 2004, 280 distal radial fractures were admitted to our orthopaedic department. They were recorded prospectively in the departmental trauma admissions database. We studied the 87 cases treated with the K-wires and plaster technique. They were classified according to the AO classification system. The mean patient age was 53 [5-88] years. The mean delay before surgery was 7 [0-24] days. We studied the complications reported by the attending orthopaedic surgical team. 48 out of 87 patients [55.1%] were reported to have complications.

We analysed the displacement and the pin tract infection, as they were the main reported complications. 28 out of 87 patients [32%] had displacement [9 had further surgery to correct the displacement, 19 did not have any further surgery as the displacement was accepted]. 11 out of 87 patients [12.6%] had pin tract infection [7 needed early removals of the K-wires and systematic treatment]. Further analysis showed no statistically significant relation between the complications rate and the age of the patients, the delay before surgery or the type of the fractures.

We demonstrate a considerable high displacement and infection rate with the use of K-wires and plaster technique for fixation of distal fracture irrespective of the age of the patients, the delay before surgery or the fracture classification. There are other methods for fixation of the distal radial fracture with proven less morbidity which should be considered.

Background. Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Lateral column injuries have historically been treated with Kirschner wire fixation when encountered. Objective. Our aim in this study was to analyse lateral column injuries to the midfoot, their method of treatment and the radiological lateral column outcomes. Our nul hypothesis being that fixation is required to obtain and maintain lateral column alignment. Methods. Data was retrospectively collected from four centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26. Results. A total of 235 cases were diagnosed as having a lateral column injury out of the 409 cases included. On cross tabulation, there was a significant association with having a central column injury (234/235, p<.001) and 70% of cases (166/235) also had an additional medial column injury. Of the 235 lateral column injuries, data was available regarding fixation radiographic alignment on 222 cases. There were 44 cases which underwent Kirschner wire fixation, 23 plate fixations and 3 screw fixations. Lateral column alignment loss was seen in 2.84% (4/141) of those which didn't undergo fixation, 13.64% (6/44) which underwent K wires, and 0 % in those fixed by screws or K wires. Conclusion. Lateral column injury occurs in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral column do not appear beneficial. The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone

Recent researches indicate that both M1 and M2 macrophages play vital roles in tissue repair and foreign body reaction processes. In this study, we investigated the dynamics of M1 macrophages in the induced membrane using a mouse femur critical-sized bone defect model. The Masquelet method (M) and control (C) groups were established using C57BL/6J male mice (n=24). A 3mm-bone defect was created in the right femoral diaphysis followed by a Kirschner wire fixation, and a cement spacer was inserted into the defect in group M. In group C, the bone defect was left uninserted. Tissues around the defect were harvested at 1, 2, 4, and 6 weeks after surgery (n=3 in each group at each time point). Following Hematoxylin and eosin (HE) staining, immunohistochemical staining (IHC) was used to evaluate the CD68 expression as a marker of M1 macrophage. Iron staining was performed additionally to distinguish them from hemosiderin-phagocytosed macrophages. In group M, HE staining revealed a hematoma-like structure, and CD68-positive cells were observed between the spacer and fibroblast layer at 1 week. The number of CD68-positive cells decreased at 2 weeks, while they were observed around the new bone at 4 and 6 weeks. In group C, fibroblast infiltration and fewer CD68-positive cells were observed in the bone defect without hematoma-like structure until 2 weeks, and no CD68-positive cells were observed at 4 and 6 weeks. Iron staining showed hemosiderin deposition in the surrounding area of the new bone in both groups at 4 and 6 weeks. The location of hemosiderin deposition was different from that of macrophage aggregation. This study suggests that M1 macrophage aggregation is involved in the formation of induced membranes and osteogenesis and may be facilitated by the presence of spacers

Introduction and Aims: A retrospective review of the medical records and radiographs of patients treated with operative fixation of two-part proximal humerus fractures was undertaken to compare the results of different modes of fixation. Comparison was made between ORIF with a blade plate, percutaneous Kirschner wire fixation, and intramedullary nail fixation utilising a Polarus nail. Method: Thirty-six patients were treated with intramedullary fixation, 11 with blade plate fixation and 10 with percutaneous fixation, utilising Kirschner wires. Union rates were 34/36 (94%) for the Polarus nail, 9/10 (90%) for K-wire fixation and 9/11 (82%) for blade plate fixation. Time to union averaged 12.4 weeks for the Polarus nail, 11 weeks for K-wire fixation and 21 weeks for blade plate fixation. Average active shoulder range of motion in forward flexion/abduction were 125/118 degrees for intramedullary nail, 132/132 degrees for the blade plate and 112/111 degrees for patients treated with K-wire fixation. Results: The major discrepancy in comparison of the different modes of fixation was in the complication rate. Ten complications occurred in the group treated with intramedullary fixation. These included one non-union, one painless fibrous non-union and back out of the proximal interlocking screw in eight patients, five of which required screw removal. Seven of 11 patients treated with blade plate fixation experienced complications, including two non-unions, two malunions, two with functionally limiting heterotopic ossification, one arthrofibrosis and one with persistent pain. The complications associated with percutaneous Kirschner wire fixation included one non-union, two malunions, four developed functionally limiting heterotopic ossification, five incidences of early pin removal secondary to pin migration, one arthrofibrosis requiring surgical intervention and one infection requiring surgical irrigation and debridement. Conclusion: Results comparable in all groups. Fewer complications seen with intramedullary fixation. Majority of complications with Polarus nail related to backing out of proximal interlocking screw. Modification of implant to include end cap, which locks the proximal screw seems to eliminate complication. Results indicate that intramedullary nail fixation is superior to blade plate fixation or pecutaneous Kirschner wire fixation for two-part proximal humerus fractures

Aims. With the ageing population, fragility fractures have become one of the most common conditions. The objective of this study was to investigate whether microbiological outcomes and fracture-healing in osteoporotic bone is worse than normal bone with fracture-related infection (FRI). Methods. A total of 120 six-month-old Sprague-Dawley (SD) rats were randomized to six groups: Sham, sham + infection (Sham-Inf), sham with infection + antibiotics (Sham-Inf-A), ovariectomized (OVX), OVX + infection (OVX-Inf), and OVX + infection + antibiotics (OVX-Inf-A). Open femoral diaphysis fractures with Kirschner wire fixation were performed. Staphylococcus aureus at 4 × 10. 4. colony-forming units (CFU)/ml was inoculated. Rats were euthanized at four and eight weeks post-surgery. Radiography, micro-CT, haematoxylin-eosin, mechanical testing, immunohistochemistry (IHC), gram staining, agar plating, crystal violet staining, and scanning electron microscopy were performed. Results. Agar plating analysis revealed a higher bacterial load in bone (p = 0.002), and gram staining showed higher cortical bone colonization (p = 0.039) in OVX-Inf compared to Sham-Inf. OVX-Inf showed significantly increased callus area (p = 0.013), but decreased high-density bone volume (p = 0.023) compared to Sham-Inf. IHC staining showed a significantly increased expression of TNF-α in OVX-Inf compared to OVX (p = 0.049). Significantly reduced bacterial load on bone (p = 0.001), enhanced ultimate load (p = 0.001), and energy to failure were observed in Sham-Inf-A compared to Sham-Inf (p = 0.028), but not in OVX-Inf-A compared to OVX-Inf. Conclusion. In osteoporotic bone with FRI, infection was more severe with more bone lysis and higher bacterial load, and fracture-healing was further delayed. Systemic antibiotics significantly reduced bacterial load and enhanced callus quality and strength in normal bone with FRI, but not in osteoporotic bone. Cite this article: Bone Joint Res 2022;11(2):49–60

Background. Evidence concerning the management of dorsal fracture dislocation (DFD) of the proximal interphalangeal joint (PIPJ) in the hand has been limited by small sample size and case heterogeneity within studies. This retrospective case control study examined clinical outcome of this specific subgroup managed by three different methods. Methods. Patients undergoing fixation of unstable DFD of the PIPJ between March 2005 and August 2011 were identified from theatre records. A retrospective review of case-notes and radiographs was undertaken to determine fracture characteristics, fixation methods and clinical outcomes. Results. 21 patients with DFD of the PIPJ were identified with a mean age of 40 years (range 22–65). The majority of patients were male (17/21, 81%) and the mean percentage articular surface involvement of fractures was 41% (Std. Dev. 11.3%). PIPJ DFD's were managed by reduction of the PIPJ and temporary transarticular K-wire fixation (12/21, 57%), hemi-hamate arthroplasty (7/21, 33%), or by open reduction and internal fixation (2/21,10%). PIPJ ROM following hemi-hamate arthroplasty was 65° (range 34–108°) and was greater than K-Wire fixation at 56. o. (range 9–85. o. ) (p = 0.82). Hemi-hamate arthroplasty and K-wire fixation resulted in fixed flexion deformity of 20° (range −12–52°) and 15° (range −6–50°) respectively (p = 0.61). Hand therapy data was available for one case undergoing ORIF with a post-operative ROM of 60° and 30° of fixed flexion. There was poor correlation between articular surface involvement and post-operative range of movement at the PIPJ (Co-efficient −0.16, p = 0.55). Conclusion. We present a relatively large series of outcomes following DFD of the PIPJ. We were unable to demonstrate any difference in post operative clinical outcomes between the fixation methods examined

Aims: We evaluated a novel modification of a technique presented by Drey and Eaton (1993). The need of temporary K-wire fixation of the MP joint was questioned by randomisation. Methods: 30 consecutive patients with late instability of the thumb UCL were randomised in two groups (group1: K-wire fixation of the MP joint for 6 weeks, group 2: no internal fixation) and operated on. External immobilisation was used for 6 weeks in both groups. The follow-ups including clinical examination, X-rays and MRI study (10 patients) were at 8 weeks, 12 and 24 months. So far 26 patients have been followed up for 1 year and 15 patients for 2 years. Results: Stability of the MP joint improved from preop.(average yield) 58o (56°vs.59°= group 1 vs. group 2, n.s.) to 18° (17° vs. 19°n.s.) at one year and to 26°(20°vs. 30°n.s.) at 2 years. Compared to the uninjured hand key pinch strength improved from preop. 74% (81% vs. 69% n.s.) to 95% (97% vs. 93% n.s.) at 1 year and to 100% (102% vs. 98% n.s.) at 2 years. The pulp pinch strength improved from preoperative 65% (68% vs. 63% n.s.) to 98% (98% vs. 97% n.s.) at 1 year and to 108% (109% vs. 107% n.s.) at two years. 18 (69%) of 26 patients (73% vs. 67%) followed at least 1 year revealed the result as good or excellent, 6 (23%) patients (27% vs. 20%) revealed the result as fair and 3 (12%) patients (9% vs.13%) revealed the result as poor. All patients returned to their previous work. Conclusions: This new technique provided good improvement in stability and strength of the thumb. Temporary K-wire fixation of the MP joint seems to have no influence on the outcome so far

There is debate whether a home run screw (medial cuneiform to 2nd metatarsal base) combined with k-wire fixation of 4th & 5th rays is sufficient to stabilise Lisfrance injuries or if fixation of the 3rd ray is also required. Unlike the 2nd, 4th and 5th TMTJ, stabilisation of the 3rd requires either intra-articular screw or a cross joint plate which both risk causing chondrolysis and/or OA. Using 8 Theil embalmed specimens, measurements of TMTJ dorsal displacement at each ray (1st to 5th) and 1st – 2nd metatarsal gaping were made during simulated weight bearing with sequential ligamentous injury and stabilisation to determine the contribution of anatomical structures and fixation to stability. At baseline mean dorsal TMTJ displacement of the intact specimens during simulated weight bearing (mm) was: 1st: 0.14, 2nd: 0.1, 3rd:0, 4th: 0, 5th: 0.14. The 1st-2nd IM Gap was 0mm. After transection of the Lisfranc ligament only, there was 1st-2nd intermetatarsal gaping (mean 4.5mm), but no increased dorsal displacement. After additional transection of all the TMTJ ligaments dorsal displacement increased at all joints (1st: 4.5, 2nd: 5.1, 3rd: 3.6, 4th: 2, 5th: 1.3). Stabilisation with the home run screw and 4th and 5th ray k-wires virtually eliminated all displacement. Further transection of the 3rd/4th inter-metatarsal ligaments increased mean dorsal displacement of the 3rd ray to 2.5mm. K-wire fixation of the 3rd ray completely eliminated dorsal displacement. The results suggest that stabilising the 2nd and 4/5th TMTJs will stabilise the 3rd if the inter-metatarsal ligaments are intact. Thus 3rd TMTJ stability should be checked after stabilising the 2nd and 4/5th. Provided the intermetatarsal ligaments (3rd-4th) are intact the 3rd ray does not need to be stabilised routinely

Introduction. The classical Colles fracture (extraarticular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture. Methods. We retrospectively analysed 72 consecutive cases of Colles fractures treated with interfragmentary K-wire fixation, in female patients over sixty years of age, in two orthopaedic centres, under the care of twelve different orthopaedic surgeons. We correlated the radiographic distal radius measurements (ulnar variance, volar tilt, and radial inclination) at the pre-operative and intra-operative stages with the final radiographic outcome. Result. Mean dorsal angulation was 21° at time of presentation. Closed reduction significantly improved fracture position to a mean of 2.7° volar angulation (p<0.05). Mean angulation at time of k-wire removal was 1.6° dorsal, this was not significant in comparison to post reduction measurements (p< 0.05). Mean ulnar variance at time of presentation was 2.5mm (range 7.4 to -4.2). Reduction improved fracture displacement to a mean of 0mm, which was statistically significant (p<0.05). Mean ulnar variance at time of k-wire removal was 2.4mm (p<0.05). 56.8% of cases demonstrated radial shortening of 2mm or more. Conclusion. In female patients over 60 years of age, the best predictor of radial length, when K-wire fixation is to be used, is the radial length prior to fracture reduction. Thus if there is radial shortening visible in the initial radiographs as measured in terms of ulnar variance, one should consider a method of fixation other than inter-fragmentary K-wires

Aims and objectives. The aim of this study was to assess the radiographic outcome by using Lindstrom grading for the management of Malone 2A and 2B fractures by 3 different methods of treatment. The three different methods included manipulation under anaesthesia, k-wire fixation and open reduction internal fixation. Methods and materials. Between March 2006 and February 2007, 62 intra-articular distal radius fractures were retrospectively selected. 31 patients including 21 females and 9 males with an average age of 62 years were classified as Malone 2A fractures and 32 patients including 18 females and 14 males with an average age of 64.5 years were classified as Malone 2B fractures. 18 patients had manipulation under anaesthetic (MUA) and immobilisation in a plaster of paris (POP) cast, 27 patients had manipulation and k-wire fixation and 17 patients had open reduction internal fixation (ORIF) of the fractures. All the patients had radiographic assessment at 6 weeks post op using Lindstrom grading. Grade 1 and 2 were considered acceptable, grade 3 and 4 were considered unacceptable. Results. In Malone 2A fractures the acceptable number of fractures were as follows −5/10 (50%) of the MUA group, 6/13(46.1%) in the k wire fixation group and 6/7 (85.7%) in the ORIF group. In Malone 2B fractures, the acceptable numbers were - nil in MUA group, 4/14 (28.6%) in k wire fixation group and 8/10 (80%) in the ORIF group. Conclusion. MUA and k wire fixation were not a good option for Malone 2B fractures as these fractures showed the best outcome with 80% acceptable results after ORIF. Malone classification can be used as a reliable predictor for deciding the treatment method for intra articular distal radius fractures as seen by the high acceptable results after ORIF for both type 2A and 2B fractures

Purpose of study: Aim was to evaluate the functional outcome of External fixation supplemented by K-wire fixation in communited fractures of lower end radius and compare the outcome in closed and open fractures treated by this method. Methods: External fixation along with K-wire fixation was done in 25 consecutive patients (mean age-41.9 years; range-20 to 72 years). According to Frykman’s classification, there were 3 Type VII fractures and 22 Type VIII fractures. 15 fractures were closed type, 4 were Open grade I, 4 were Open grade II and 2 were Open grade III according to Gustilo and Anderson classification. The mean follow-up period was 14.1 months (range- 6 to 25 months). Results: The mean union time was 7 weeks (range-5 to 8 weeks). Mean dorsiflexion was 37.6 degrees, mean palmar flexion was 44.4 degrees, mean ulnar deviation was 16.2 degrees, mean radial deviation was 14.2 degrees, mean supination was 73 degrees and mean pronation was 79 degrees. Comparison of union time, dorsiflexion, palmarflexion, ulnar deviation, radial deviation, supination and pronation between closed, Open grade I, Open grade II and Open grade III fractures revealed no significant difference. Significant radial shortening was observed in patients with open fractures (P=0.004). 1 patient developed schanz pin tract infection and late distal radioulnar joint subluxation was seen in 4 patients. Conclusion: Supplementation of External fixator with K-wires is an effective method for treating both closed and open fractures of distal end radius however; radial shortening is seen in some cases with open fractures