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Case report: Complications of using ‘hinged’ Kirschner wires for fixation of patellar tendon rupture
Letters to the Editor / Injury, Int. J. Care Injured 43 (2012) 386–393
390
Letter to the Editor Case report: Complications of using ‘hinged’ Kirschner wires for fixation of patellar tendon rupture
Introduction With reference to:1 Giles SN, Morgan-Jones MF, Brown MF. The use of hinged Kirschner wires for fixation of patellar tendon Rupture. Injury 1999;30:539–40. A brief overview highlighting one of the possible late postoperative complications. Case report Mr. LP was an 86-year-old gentleman with short term memory loss and poor mobility secondary to arthritis. He normally mobilised with a frame or used a wheelchair but was not steady on his feet and required four carer visits per day. He was acutely admitted following a fall from standing height. He complained of, a painful right knee and an inability to stand. There was a small amount of soft tissue swelling but no obvious bruising. He was unable to straight leg raise or weight bear despite muscular effort and was reluctant to flex his right knee because of severe discomfort. His knee ligaments appeared to be intact and there was no compromise in distal neurovascular status. In addition to bilateral hip replacements and a left knee replacement, he had undergone a ‘Hinged Kirschner wire fixation’ of his patellar tendon 27 months previously, following a traumatic rupture. No peri-operative complications were documented. He had a delayed post-operative course because of slow rehabilitation and development of pressure sores. Despite initial plans to remove the wire at three months, they were never removed as he was lost to follow up. X-rays confirmed an undisplaced proximal tibial # at junction of metaphysis and diaphysis at the point of the drill hole of the previous repair (Figs. 1 and 2). He has been subsequently managed conservatively in a long leg cast, but faces difficulties with his mobility and has limited functional rehabilitation potential.
Fig. 2.
Conclusions With the right patient selection the use of hinged Kirschner wires for fixation of patellar tendon rupture is an effective method of restoring functionality, but as described by the authors of the original article, the wires should be removed at three months, particularly in the elderly and osteoporotic, to prevent a proximal tibial stress riser and minimise the risk of delayed fracture. Conflict of interest The author declares that there are no conflicts of interest. Reference 1. Giles SN, Morgan-Jones MF, Brown MF. The use of hinged Kirschner wires for fixation of patellar tendon Rupture. Injury 1999;30:539–40.
Richard A. Mount* Rotherham General Hospital, Orthopaedics, Moorgate, Rotherham, South Yorkshire S60 2UD, United Kingdom *Tel.: +44 07962253088 E-mail address: [email protected] doi:10.1016/j.injury.2010.08.026
Letter to the Editor MUSCULO – SKE Wii TAL MEDICINE
Wiintroduction
Fig. 1.
The ‘‘Wii’’, Nintendo’s 5th home console, has taken the world by storm. It was launched in November 2006 and, as of March 2009, has sold more than 50 million units worldwide – making it the fastest selling console in history.13 The Wii is a dramatic new evolution in the world of video games. Where other console manufactures have made innovations in their next generation systems through improved graphics or processor speeds, Nintendo has created a system that has changed the essence of how video games are played.
390
Letter to the Editor Case report: Complications of using ‘hinged’ Kirschner wires for fixation of patellar tendon rupture
Introduction With reference to:1 Giles SN, Morgan-Jones MF, Brown MF. The use of hinged Kirschner wires for fixation of patellar tendon Rupture. Injury 1999;30:539–40. A brief overview highlighting one of the possible late postoperative complications. Case report Mr. LP was an 86-year-old gentleman with short term memory loss and poor mobility secondary to arthritis. He normally mobilised with a frame or used a wheelchair but was not steady on his feet and required four carer visits per day. He was acutely admitted following a fall from standing height. He complained of, a painful right knee and an inability to stand. There was a small amount of soft tissue swelling but no obvious bruising. He was unable to straight leg raise or weight bear despite muscular effort and was reluctant to flex his right knee because of severe discomfort. His knee ligaments appeared to be intact and there was no compromise in distal neurovascular status. In addition to bilateral hip replacements and a left knee replacement, he had undergone a ‘Hinged Kirschner wire fixation’ of his patellar tendon 27 months previously, following a traumatic rupture. No peri-operative complications were documented. He had a delayed post-operative course because of slow rehabilitation and development of pressure sores. Despite initial plans to remove the wire at three months, they were never removed as he was lost to follow up. X-rays confirmed an undisplaced proximal tibial # at junction of metaphysis and diaphysis at the point of the drill hole of the previous repair (Figs. 1 and 2). He has been subsequently managed conservatively in a long leg cast, but faces difficulties with his mobility and has limited functional rehabilitation potential.
Fig. 2.
Conclusions With the right patient selection the use of hinged Kirschner wires for fixation of patellar tendon rupture is an effective method of restoring functionality, but as described by the authors of the original article, the wires should be removed at three months, particularly in the elderly and osteoporotic, to prevent a proximal tibial stress riser and minimise the risk of delayed fracture. Conflict of interest The author declares that there are no conflicts of interest. Reference 1. Giles SN, Morgan-Jones MF, Brown MF. The use of hinged Kirschner wires for fixation of patellar tendon Rupture. Injury 1999;30:539–40.
Richard A. Mount* Rotherham General Hospital, Orthopaedics, Moorgate, Rotherham, South Yorkshire S60 2UD, United Kingdom *Tel.: +44 07962253088 E-mail address: [email protected] doi:10.1016/j.injury.2010.08.026
Letter to the Editor MUSCULO – SKE Wii TAL MEDICINE
Wiintroduction
Fig. 1.
The ‘‘Wii’’, Nintendo’s 5th home console, has taken the world by storm. It was launched in November 2006 and, as of March 2009, has sold more than 50 million units worldwide – making it the fastest selling console in history.13 The Wii is a dramatic new evolution in the world of video games. Where other console manufactures have made innovations in their next generation systems through improved graphics or processor speeds, Nintendo has created a system that has changed the essence of how video games are played.