پین کیرشنر ( Kirschner wire )
پین کیرشنر k wire ، متاکارپال : این پین ها از جنس استیل ضد زنگ هستند و داراری نوک صاف یا دنده دار با یک تروکار و نوک لوزی شکل در یک طرف آن یا دوطرف آن می باشد .
این پین ها در سایز های 1/6 – 0/7 -میلی متر ( 0/820 – 0/260 اینچ ) موجود هستند .
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مورد استفاده : از این پین جهت ثابت کردن شکستگی های استخوانی و تراکنش های اسکلتی استفاده می گردد .
این پین ها اغلب در استخوان های کوچک مثل انگشتان ، مچ دست و مچ پا به کار می رود و اغلب از طریق پوست به درون آن ها وارد می گردد .
توضیحات بیشتر : در هنگام کار با این وسیله ، باید مراقب بود زیرا نوک تیز آن می تواند به راحتی به پوست آسیب بزند .
Original Article
Volar locking plate fixation versus Kirschner wire
fixation in distal radius fractures: a meta-analysis
Jin Shao1*, De-Ce Kong2*, Tie-Yi Yang1
1Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, 219 Miaopu Road, Pudong New Area, Shanghai, China; 2Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia, China. *Equal contributors.
Received January 21, 2016; Accepted May 12, 2016; Epub August 15, 2016; Published August 30, 2016
Abstract: Objective:
The superiority of volar locking plate fixation and K-wire fixation on treatment of distal radius fractures was controversial.
Thus, we performed a meta-analysis to compare the efficacy of volar locking plate and K-wires for distal radius fracture.
Methods: We searched Embase, Medline and PubMed for randomized controlled trials which compare the effects of volar locking plate and K-wire on treatment of distal radius fracture.
Data analysis was performed by using the RevMan5.
Results:
Six studies met the inclusion criteria.
The meta-analysis results showed volar locking plate fixation led to better DASH scores at 3 and 12 months, faster recovery of grip strength, extension and supination at 3 months.
But there was no significant difference at 12 months in term of functions and motions recovery.
Complications of the two methods were similar.
Conclusion:
The patients receiving fixation with volar locking plate for the treatment of distal radius fracture achieved an early recovery of function compared to those with K-wire.
Keywords:
Distal radius fractures, fracture fixation, internal, volar locking plate, kirschner wire, meta-analysis
پین کیرشنر
Introduction
Distal radius fracture is one of the most common orthopedic injuries, which occurs in a proportion of approximate 25% [1].
It affects all age groups and is more common in older patients especially those with osteoporosis [2].
Therapeutic alternatives for distal radius fracture included surgical and non-surgical treatment.
Non-surgical treatment is used if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic device.
If this is not possible, surgical fixation is performed.
External fixation (EF) with Kirschner (K)-wire has historically been used for distal radius fractures
More recently, internal
fixation (IF) with a volar locking plate is becoming popularity and trends to replace K-wire fixation
Favorers suggest that internal fixation
with a volar locking plate results in a rapid functional recovery.
However, the others favor
K-wire because it is less expensive and has
smaller surgical trauma with shorter operation time.
To data, the therapeutic option for distal
radius fractures is still controversial.
Recently, some meta-analyses of randomized
controlled trials (RCTs) have compared EF with
IF for treatment of distal radius fractures [7-9].
Those studies compared different types of plate fixations with K-wire fixation or other EFs.
There was still lack of study directly comparing volar locking plate with K-wire.
Thus, we performed this meta-analysis to evaluate clinical outcomes comparing volar locking plate fixation with K-wire fixation.
Kirschner wire
Materials and methods
Search strategy and inclusion criteria We searched Embase, Medline and PubMed for RCTs from January 1990 to August 2014.
The key words “distal radius fracture” with the limits “randomized controlled trial” were used in screening relevant citations. Language restriction was not imposed in our search.
The inclusion criteria were:
(1) the studies were random-
ized controlled trials on patients with distal radius fractures;
(2) the studies compared volar locking plate with Kirschner wire; (3) the fellow up was above 12 months.
Data extraction and quality assessment The following information from each study was
extracted independently by two reviewers:
first author name; year of publication;
number of patients; the disabilities of arm, shoulder, and hand (DHAS) score; patient rated wrist evaluation (PRWE) score;
grip strength; range of motion; number of complications. The complications during the 12 months follow up were analyzed.
The Jadad score was used to assess the quality of the included studies.
The studies with score no less than 3 were regarded as high quality RCTs, while studies with score less than 3 were defined as low quality RCTs.
Kirschner wire
Data analysis We measured the primary outcome DASH and
PRWE scores and the outcomes of grip strength, forearm range of motion and complication parameters.
Data analysis was performed by
using the RevMan5.
For each individual study,
dichotomous data were reported as odds ratio
(OR) with 95% CI and continuous data were
reported as weighted mean difference (WMD)
with 95% CI. Heterogeneity between studies
was assessed by I-square test.
A significant
level of no less than 50% for I-square test was
considered as evidence of heterogeneity.
Fix
effect model was used when there was no evidence of heterogeneity, otherwise random
effect model was chosen.
To evaluate the stability of the results of this meta-analysis, we
performed a one-way sensitivity analysis, in
which we evaluated the influence of individual
studies by estimating the average relative risk
in the absence of each study [11].
Kirschner wire
Results
Search results and characteristics
A total of 851 citations were obtained via database searches; six met the inclusion criteria for
this study (Figure 1).
A total of 820 patients
with distal radius fractures were involved in this
study, in which 409 patients were treated with
volar locking plates, and 411 patients were
treated with K-wires.
The information in these
citations is summarized in Table 1. Because of
the obvious nature of intervention, it is impossible to perform double blind. All 6 studies have
been assessed by Jadad score system with
score no less than 3 (Table 1).
Kirschner wire
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