Temporary Transarticular K-wire Fixation of Critical Ankle Injuries at Risk: A Neglected “Damage Control” Strategy?

Friedman, Jamie L.; Ly, Anhchi; Mauffrey, Cyril; Stahel, Philip F.

doi:10.3928/01477447-20150204-05

Cited by 11 publications

(14 citation statements)

References 41 publications

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“…The subjective outcome scores at a median follow-up period of 2 years using the Foot and Ankle Outcome Score questionnaire found that most patients recovered well. 10 These findings support that the 2.0-mm-diameter drill holes placed through the subtalar joints may not induce the clinically relevant articular damage that can manifest in secondary postinjury arthritis development. Given the nature of these generally high-energy intra-articular injuries and will be impossible to know if the additional join damage from a few small pin penetrations can have a long-term impact on the fate of the joint.…”

Section: Discussionsupporting

confidence: 66%

“…A considerable concern is that the penetrating K-wire could damage the subtalar joint surface and accelerate the onset of subtalar arthritis. Friedman et al 10 reported the clinical results of temporary transarticular ankle pin fixation in critical ankle injuries. The subjective outcome scores at a median follow-up period of 2 years using the Foot and Ankle Outcome Score questionnaire found that most patients recovered well.…”

Section: Discussionmentioning

confidence: 99%

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Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Park

Kim

et al. 2021

Foot Ankle Int.

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Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Park

Kim

et al. 2021

Foot Ankle Int.

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“…But the results support that already during initial fracture stabilization with an AEF, the option of prolonged or final treatment with an EF should be considered in polymorbid geriatric patients [11,12,18]. Depending on the soft tissue situation and the fracture morphology, additional less invasive osteosyntheses should be considered [7,19,20]. There is no uniform approach to additive procedures either in the current literature or in our institution, which reflects a limitation of the present study.…”

Section: Discussionmentioning

confidence: 52%

“…On the one hand, additional procedures may be temporary and will be removed during conversion to ORIF or at the time of EF removal after fracture healing, e.g., temporary retrograde calcaneotalotibial K-wire stabilization. It could be shown that temporary retrograde calcaneotalotibial K-wire stabilization is not an obvious trigger for osteoarthritis in this patient group [19,20]. Without additional external stabilization, good radiological results are only achieved in 33% [12].…”

Section: Discussionmentioning

confidence: 77%

The AO triangular external fixator: a backup option in the treatment of ankle fractures in geriatric patients?

Hennings¹,

Spiegl²,

Fakler³

et al. 2020

Eur J Orthop Surg Traumatol

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Purpose To analyze the indications, radiological short-term outcomes, and complications of ankle fractures in geriatric patients treated with a triangular external fixator (AEF) until fracture healing. Furthermore, the effect of an additional osteosynthesis to AEF on the radiological outcome was investigated. Methods Retrospective analysis of ankle fractures treated in a Level I Trauma Center between 2005 and 2015 with an AEF in patients aged ≥ 65 years until fracture has healed. The combination of AEF and at least one additional osteosynthesis of a malleolus was defined as hybrid external fixator (HEF). At the time of AEF removal, a preserved ankle joint congruity was defined as good radiological outcome. Incongruity more than 2 mm was defined as poor radiologic results. Results 16 patients (13 women, 3 men) with a mean age of 74 years (SD 6.2) were treated with AEF until fracture healing, 9 with a single AEF and 7 with a HEF. Stabilization with HEF (n = 7 [100%]) showed higher rates of good radiological outcome than AEF alone (n = 4 [44%] of 9; p = 0.034). The duration of therapy did not differ between HEF and AEF (70 day vs 77 days). 4 patients (22%) required surgical revision. Conclusion It could be shown that osteosynthesis in addition to AEF leads to a better radiological short-term results than using AEF alone. Therefore, in the situation where an AEF is considered as the definitive treatment option for an ankle fracture in geriatric patients with expected or existing soft tissue problems, it should be done or completed as a HEF. Level of evidence Therapeutic level IV.

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“…To prevent pin site infection, cleansing with hydrogen peroxide, chlorhexidine gluconate (CHG), or saline appears safe and beneficial [12]. In addition to external fixation, percutaneous fixation using Kirschner wires or screws have been shown to be valuable adjuncts in temporary management of fractures and dislocations of both upper and lower extremity injuries [13].…”

Section: Temporary Stabilizationmentioning

confidence: 99%

Challenges in definitive fracture management of blast injuries

Gordon

Kuhn

Staeheli

et al. 2015

Curr Rev Musculoskelet Med

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The United States military remains engaged in the longest armed conflict in this nation's history. The majority of casualties in the global war on terror come from blast-related injuries. Multiple centers have published their experience and outcomes with these complex patients. Findings from the study of injured military personnel have implications for mass casualty events resulting from industrial accidents or terrorism in the civilian sector. This article will review the pathophysiology of blast-related injury. The authors will summarize treatment considerations, priorities, and techniques that have proven successful. Finally, the authors will discuss the incidence and management of common complications after blast-related injuries.

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Temporary Transarticular K-wire Fixation of Critical Ankle Injuries at Risk: A Neglected “Damage Control” Strategy?

Cited by 11 publications

References 41 publications

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

The AO triangular external fixator: a backup option in the treatment of ankle fractures in geriatric patients?

Challenges in definitive fracture management of blast injuries

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