Tension band fixation is the most common form of internal fixation used for non-comminuted olecranon fractures. It is typically reserved for noncomminuted fractures that are proximal to the coronoid. This procedure is performed using Kirschner wire (K-wires) which converts tensile forces into compressive force.
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Arthrodesis of the CMC1 joint is a surgical procedure in which the trapezium bone and the metacarpal bone of the thumb are secured together. Because the joint is fixed, and therefore can not be moved, the complaints of the patient are mainly gone. During the surgery the two bones will be fixated using K-wires. The use of plates and screws has also been described.
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The tendons of the toe are attached to those of the radial flexor and extensors muscles of the wrist to create more stability to the MTP joint. K-wires are placed to fixate the bones in the desired position. Once the bones are secured anastomosis are made between the vessels of the toe and the vessels of the forearm. After revascularization of the toe, the skin paddle is placed and the skin is closed.
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The plate usually is left inside the patient's wrist, while the wires (usually K-wires) have to be removed in a second surgery. This procedure of partial wrist fusion allows for limited wrist movement, whereas total wrist fusion immobilizes the wrist permanently. Following surgery it can take several months for affected patients to regain strength. Unfortunately both of these operations are salvage procedures and movements in the wrist will be significantly reduced.
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If the wrist also has ulnar deviation, more bone can be taken from the radial side to correct this abnormality. This position is held into place with two cross K-wires. In addition, a tendon transfer of the extensor carpi ulnaris to the extensor carpi radialis brevis may be performed to correct ulnar deviation or wrist extension weakness, or both. This tendon transfer is only used if the extensor carpi ulnaris appears to be functional enough.
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Most of the diseased tissue is removed with these procedures. For some individuals, the partial insertion of "K wires" into either the DIP or PIP joint of the affected digit for a period of a least 21 days to fuse the joint is the only way to halt the disease's progress. After removal of the wires, the joint is fixed into flexion, which is considered preferable to fusion at extension. In extreme cases, amputation of fingers may be needed for severe or recurrent cases or after surgical complications.
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K-wires are typically removed after six weeks, before weight bearing, while screws are often removed after 12 weeks. When a Lisfranc injury is characterized by significant displacement of the tarsometatarsal joint(s), nonoperative treatment often leads to severe loss of function and long-term disability secondary to chronic pain and sometimes to a planovalgus deformity. In cases with severe pain, loss of function, or progressive deformity that has failed to respond to nonoperative treatment, mid-tarsal and tarsometatarsal arthrodesis (operative fusion of the bones) may be indicated.
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Intraoperative X-Ray of a humerus fixated by Kirschner wires Kirschner wires or K-wires or pins are sterilized, sharpened, smooth stainless steel pins. Introduced in 1909 by Martin Kirschner, the wires are now widely used in orthopedics and other types of medical and veterinary surgery. They come in different sizes and are used to hold bone fragments together (pin fixation) or to provide an anchor for skeletal traction. The pins are often driven into the bone through the skin (percutaneous pin fixation) using a power or hand drill.
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A 2005 study suggests that closed reduction and Kirschner wire (K-wire) stabilisation or open reduction and stabilisation - generally using screws to avoid the complication of K-wires and maintain a stable reduction - are the treatments of choice. According to a 1997 study, for severe Lisfranc injuries, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire fixation is the treatment of choice. The foot cannot be allowed to bear weight for a minimum of six weeks. Partial weight-bearing may then begin, with full weight bearing after an additional several weeks, depending on the specific injury.
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