Combined use of Kirschner wires and hinged external fixator for capitellar and trochlear fractures: a minimum 24‐month follow‐up

Abstract

Background: Open reduction and internal fixation is the adequate treatment for capitellar and trochlear fractures. Given the low incidence of this type of fractures, it is difficult to constitute a universally accepted method for fixation. Thus, we hypothesised that combined use of Kirschner wires (K-wires), absorbable rods and sutures for fixation and post-operative hinged external fixator for early rehabilitation exercise can restore elbow joint function well. Methods: This retrospective study included 20 patients with a mean age of 48.3 (range 16-76) years. According to the Dubberley classification, fractures were classified on plain radiographs, computed tomography images and intra-operative findings. All patients were evaluated by the range of motion of the elbow and the Broberg-Morrey score. Results: All fractures had healed without non-union, and the average time was 13.6 (range 8-17) weeks. The mean follow-up was 42.5 (range 24-80) months. The mean flexion was 117.1 (range 90 -135 ), and the mean extension was 17.5 (range 0 -45 ). The mean pronation was 74.4 (range 45 -85 ), and the mean supination was 84.3 (range 60 -90 ). The average Broberg-Morrey score was 86.2 (range 68-98) points with 10 excellent, 7 good and 3 fair results. Conclusion: K-wires, absorbable rods and sutures combined with hinged external fixator are feasible for fixation of capitellar and trochlear fractures. However, due to the absence of a control group (such as Herbert screw fixation), comparative studies are still needed to demonstrate the safety and reliability of K-wires for fixation.

Coronal Shear Fractures of the Distal Humerus

“…Although Kirschner wires have been found to provide lower functional outcomes compared with screws, they are an option, particularly in cases characterized by small fracture fragment size [ 64 , 65 ]. They can be used either isolated or in association with other methods, such as external fixation [ 66 , 67 ]. Threaded Kirschner wires are preferred to smooth ones to minimize the risk of migration.…”

“…In order to overcome this limitation, the addition of a hinged external fixator has been proposed. He et al, after 42.5 months of follow-up, have retrospectively reported 10 excellent, seven good and three fair results according to the Broberg–Morrey score, with good elbow mobility and no wires loosening [ 67 ]. In addition, at 12 months of follow-up, good results have been obtained using fine-threaded Kirschner wires (FFS OrthofixTM, Bussolengo, Italy) due to their autocompression effect, in a cohort of 15 patients reported by Heck et al [ 9 ].…”

Are outcomes after fixation of distal humerus coronal shear fractures affected by surgical approach? A systematic review and meta-analysis

“…2009 14 IV 27 NR NR NR NR 3, 24 Ring: 1 (1); 2 (1); 3 (9); 4 (15); 5 (1) NR He et al. 2019 16 IV 20 12:8 48.3 (16-76, 15) 13,7,0 NR 17,3 NR 42.5 Heck et al. 2012 17 IV 15 11:4 35.7 (13-72, 14.75) NR 7,3,2,3 13,2 NR 58.5 Hussain et al.…”

“…2009 14 27 NR NR NR NR NR NR NR 8 0 9 0 0 0 He et al. 2019 16 20 99.6 17.5 117.1 NR NR 10 7 15 2 6 4 1 14 Heck et al. 2012 17 15 124 NR NR 173 90 7 7 15 0 8 0 0 0 Hussain et al.…”

“…2009 14 38 22 0 3 2 1 15 0 0 He et al. 2019 16 20 14 0 6 0 0 0 0 1 Heck et al. 2012 17 15 15 0 0 0 0 0 0 1 Hussain et al.…”