Factors influencing K-wire migration in tension-band wiring of olecranon fractures
Factors influencing K-wire migration in tension-band wiring of olecranon fractures
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DOI：
10.1016/j.jse.2014.02.018
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发表时间：
2014-08-01
影响因子：
3
通讯作者：
Matthews, Timothy J. W.
中科院分区：
文献类型：
--
作者：
Saeed, Zubair M.;Trickett, Ryan W.;Matthews, Timothy J. W.
背景：张力带钢丝是治疗单纯性尺骨鹰嘴骨折的常用内固定方法。虽然骨折愈合率和临床结果良好，但多达80%的患者因突出/有症状的金属制品而需要取出。目前的文献仍然不清楚纵向导线的最佳方向，以最大限度地减少硬件故障。这项研究的目的是确定与自发性钢丝拔出相关的手术可修改因素。方法：对6年来医院剧场记录进行回顾，以确定所有尺骨鹰嘴张力带钢丝手术。采用术前X线片对骨折进行确认和分类。对术中和术后的钢丝相关变量进行分析：尺骨内钢丝长度、髓/皮质位置、钢丝的平行度、近端钢丝突起、钢丝相对于尺骨的角度、距关节面的距离、骨折间隙以及随后的拔出。平均年龄52.5岁，平均随访7.3个月。髓内钢丝平均拔出5.5 mm，而经皮质钢丝平均拔出2.4 mm(P<；.0001)。多元回归模型显示了7个影响钢丝拔出的独立变量：年龄、钢丝弯曲、髓内/经皮质钢丝位置、近端隆起、尺骨干角度、距关节面的距离和关节步长。结论：为了最大限度地减少术后钢丝拔出，我们建议在靠近关节面的软骨下骨中解剖复位，不弯曲钢丝。证据水平：II级，回顾设计，预后研究。(C)2014年《肩肘外科杂志》董事会。
Background: Tension-band wiring is a popular method of internal fixation for simple olecranon fractures. Although fracture union rates and clinical outcomes are good, up to 80% of patients require removal because of prominent/symptomatic metalwork. The current literature remains unclear as to the best orientation of the longitudinal wires to minimize hardware failure. The aim of this study was to determine the surgically modifiable factors related to spontaneous wire pullout.Methods: A retrospective review of hospital theater records over a period of 6 years was performed to identify all olecranon tension-band wire procedures. Preoperative radiographs were used to confirm and classify the fracture. Intraoperative and postoperative radiographs were analyzed for a number of wire-associated variables: wire length within the ulna, medullary/cortical position, parallelism of wires, proximal wire prominence, wire angle relative to the ulna, distance from the articular surface, fracture gap, and subsequent pullout.Results: A total of 182 wires were analyzed. The mean age was 52.5 years, and the mean radiographic follow-up period was 7.3 months. Intramedullary wires had a mean pullout of 5.5 mm compared with 2.4 mm for transcortical wires (P < .0001). A multiple regression model noted 7 independent variables affecting wire pullout: age, bent wires, medullary/transcortical wire positioning, proximal prominence, ulnar shaft angle, distance from the articular surface, and articular step.Conclusion: To minimize postoperative pullout of wires, we suggest anatomic reduction and transcortical wire orientation, without bending, in the subchondral bone close to the articular surface.Level of evidence: Level II, Retrospective Design, Prognosis Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.