Chan K W, Donnelly K J
Altnagelvin Area Hospital, Glenshane Road, Londonderry BT47 6SB, United Kingdom.
J Orthop. 2014 Jun 17;12(2):111-7. doi: 10.1016/j.jor.2014.04.018. eCollection 2015 Jun.
Despite the recognised complications of migration of wires and soft tissue irritation, tension band wiring (TBW) remains the gold standard for fixation of displaced, minimally comminuted olecranon fractures. There is much variation in placement of the K-wires with current AO guidance stating that each wire should be drilled through the anterior cortex and then backed up by 1 cm. The aim of this study was to examine the effect of K-wire position (intramedullary vs. transcortical) on stability of the construct and significant local complications.
All patients who underwent TBW for an isolated olecranon fracture in our trauma unit between 1/1/2009 and 31/12/2011 were included in this retrospective study. Mean follow-up was 14 months (range 5-29 months). Data was gathered from medical records and radiographs. The outcome measured was removal of metal due to complications such as wound problems or proximal migration of wires as standard practice within out trauma unit.
Sixty-three patients met the inclusion criteria. Forty-seven had an intramedullary compared with 16 with transcortical configuration (ratio 3:1). Nine patients (19%) with intramedullary K-wires required removal of metalwork - seven due to prominent metalwork and two with wound infection. Four patients (25%) with transcortical K-wires required removal of metalwork - three due to prominent metalwork and one with failure of metalwork. There was no significant statistical difference between transcortical and intramedullary K-wire placement with regards to complication rates following tension band wiring of an isolated olecranon fracture requiring removal of metal (Chi squared test with Yates' correction p = 0.89).
We concluded that we found no difference in complications or metalwork removal rate in the placement of K-wire in tension band wiring for isolated olecranon fracture. We recognise our study was limited by small numbers and is based on the experience of one trauma unit.
尽管钢丝移位和软组织刺激等并发症已得到公认，但张力带钢丝固定术（TBW）仍是移位的、轻度粉碎性鹰嘴骨折固定的金标准。目前AO指南对克氏针的放置有很大差异，规定每根针应从前侧皮质钻孔，然后后退1厘米。本研究的目的是探讨克氏针位置（髓内与经皮质）对固定结构稳定性和显著局部并发症的影响。
本回顾性研究纳入了2009年1月1日至2011年12月31日期间在我们创伤科接受TBW治疗孤立性鹰嘴骨折的所有患者。平均随访时间为14个月（范围5 - 29个月）。数据从病历和X光片中收集。作为我们创伤科的标准做法，测量的结果是因伤口问题或钢丝近端移位等并发症而取出金属内固定物。
63例患者符合纳入标准。47例采用髓内克氏针，16例采用经皮质配置（比例为3:1）。9例（19%）髓内克氏针患者需要取出金属内固定物——7例是因为金属内固定物突出，2例是因为伤口感染。4例（25%）经皮质克氏针患者需要取出金属内固定物——3例是因为金属内固定物突出，1例是因为金属内固定物失效。在孤立性鹰嘴骨折张力带钢丝固定后需要取出金属的并发症发生率方面，经皮质和髓内克氏针放置之间没有显著统计学差异（采用Yates校正的卡方检验，p = 0.89）。
我们得出结论，在孤立性鹰嘴骨折的张力带钢丝固定中，克氏针放置的并发症或金属内固定物取出率没有差异。我们认识到我们的研究受样本量小的限制，且基于一个创伤科的经验。
