Arch Hand Microsurg.  2024 Mar;29(1):34-39. 10.12790/ahm.23.0039.

Transosseous wiring method for simple transverse shaft fracture of the upper extremity

• Choi S
• Jung SY
• Kim MB

• KMID: 2553169
• DOI: http://doi.org/10.12790/ahm.23.0039

Abstract

Purpose
A diaphyseal simple transverse fracture (DSTF) of the upper extremity (UE) requires direct anatomical reduction and absolute stability. No standard efficient method exists for reducing and maintaining a DSTF, despite its importance. Here, we introduce our transosseous wiring (TOW) method for UE-DSTFs.
Methods
To maintain reduction, the UE-DSTF was first fixed with TOW before definitive fixation with a locking plate across the fracture. We retrospectively reviewed 15 patients with at least 1 year of postoperative follow-up treatment from 2019 to 2021.
Results
All patients had achieved anatomical reduction and bone union at the final follow-up. Three patients had hardware removed because of irritation caused by the plate and screws. However, none of those three patients complained of irritation from the wire. One patient experienced refracture at the same site after hardware removal after a fall. The same technique was used in this case, and the bone union was observed 6 months after surgery.
Conclusion
TOW is a simple straightforward method that can be applied without special instruments. It could be an efficient method for interfragmentary compression and attachment of a locking plate without the burden of maintaining the reduction of UE-DSTFs.

Keyword

Diaphyseal simple transverse fracture; Simple shaft fracture; Transverse fracture; Transosseous wiring; Interfragmentary compression

Figure

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  Fig. 1. Simple radiographs and gross image show various cases treated with our method. (A) A Galeazzi fracture shows a small butterfly fragment of a radial shaft fracture, which could be regarded as a simple transverse fracture. (B) A gross image shows the surgical field after the wiring between the fracture fragments. The radius is reduced anatomically with suboptimal stability, which can be tolerable for plate fixation. (C) After the application of transosseous wiring, the fracture is checked with intraoperative fluoroscopy. This provisional construct could be stable enough to be applied with the plate. (D) The final outcome of surgical treatment shows cortical bridging with minimal callus formation. The black arrows indicate the callus and bone diameters, which are measured for the callus index (callus diameter/bone diameter). (E) This image shows the application of this technique for a humerus shaft fracture. (F) These images show the clavicle shaft fracture using our method.

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  Fig. 2. (A) A 23-year-old male patient had a radial shaft simple transverse fracture. (B) At 13 months postoperatively, fracture consolidation was confirmed. (C) The patient requested implant removal because of plate discomfort. (D) The fracture recurred 4 months after removal surgery at the same site as the initial fracture. (E) The same procedure was performed with transosseous wiring and longer locking plating, and 7 months after the second operation, the bone showed complete healing.

Reference

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