SLR - January 2024 - McGowan
Title: Comparison of Temporary External and Percutaneous K-Wire Fixations for Treatment of Ankle Fracture – DislocationsReference: Xie W, Li H, Zhang C, Cui X, Zhang S, Rui Y, Chen H. Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture-dislocations. BMC Musculoskelet Disord. 2023 Nov 11;24(1):880. doi: 10.1186/s12891-023-07020-6. PMID: 37951888; PMCID: PMC10638746.
Level of Evidence: Level 4 Retrospective Study
Scientific Literature Review
Reviewed By: Ryan Casey McGowan, DPM PGY-3
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: Ankle fractures are one of the most commonly encountered traumatic injuries not only in lower extremity surgery, but all of orthopedic trauma surgery. While there are many different philosophies and techniques to approaching the fixation of these injuries, it is thoroughly agreed upon that delicate handling of the soft tissue is a very important factor in successful outcomes. This becomes even more important when the ankle fractures are dislocated. External fixation is a commonly used to reduce and stabilize ankle dislocations. The authors of this study wanted to test a less invasive, percutaneous management of ankle fracture dislocations using K-wires, and they hypothesized that this method would lead to less complications and better outcomes that standard external fixation.
Methods: This retrospective study included 67 patients who were treated at a single institution for management of ankle fracture dislocations before definitive internal fixation. 30 patients were treated with K-Wires, while 37 receviedexternal fixation. Primary outcome measures were the rates of complications including skin necrosis, re-dislocation of the ankle, pin-site infection, surgical wound infection and post traumatic ankle arthritis. Clinical results were evaluated using the AOFAS ankle-hindfoot score and 10-point VAS Score.
Results: The authors found no significant difference in the complication rates between percutaneous K-wire and External Fixations, except when comparing pin site infections. The patients treated with external fixators experienced more pin site infections. Clinical follow up between these two groups yielded very similar AOFAS Ankle-Hindfoot and VAS Scores, demonstrating safe effective use of each method of fracture stabilization.
Conclusions: Although this retrospective study had limited sample sizes, the authors were able to make several deductions from the data. The positive clinical outcomes showed the K-Wire stabilization method to be safe and effective when treating ankle fracture dislocations. The complication rates were low and similar to those seen with external fixation, demonstrating this as a suitable treatment option. Ankle fracture dislocations are complicated injuries that can have seriously negative outcomes if not handled properly. External fixators often come with compliance and patient satisfactions issues. This study provides information on a suitable treatment option that may help avoid the negative impacts external fixators can have on patients.