Kirschner wires for Colles’ fracture

Letters to the Editor theatre very rapidly (time to surgery–—average 4 days). I would like to make the following points: (1) Although they talk about the fractures being undisplaced or non displaced, the illustration that they show (Fig. 1) had certainly displaced more than 2 mm. If Fig. 5 is the same patient then they have in fact reduced the fracture (on the one view that is available). They do not talk in their paper about reduction and seem to reserve this technique for undisplaced fractures or non displaced fractures. Is Fig. 5 the same case as Fig. 4? (2) The Paper would have carried more weight and been more interesting if they had also commented on examination under anaesthetic. Whilst the patient is asleep, these fractures could have been stressed to see if they would displace. If under physiological load they would not displace then I believe that an operation in the way of percutaneous pinning would not be required. Why have the authors not included in their study a description of examining the fractures under an anaesthetic to prove instability? (3) Finally, I am also interested in their classification. They say that the fracture was classified according to Letournel on the basis of radiographs. They do not say whether or not patients had pre operative CT scans. They note that the patient group that they treated had either transverse, two column or T type fractures. Again the fracture that they have illustrated in Fig. 4 is mainly an anterior column fracture with perhaps impaction of the dome. Unless there is a hidden fracture in the iliac blade, the illustration in Fig. 4 does not actually fit with any of the classifications that they include in their series. This is an interesting series and certainly in the UK where resources are stretched, it may be best to perform an examination of the hip under a ‘C arm’ with the patient awake. It is easy to tell from the patient without causing them any distress whether or not a fracture is unstable. In this way, many of these patients could avoid unnecessary and potentially dangerous operations. Those that would be unstable and potentially displaced could then be selected for operation. Although there were no complications in this series, I am very concerned that patients can be damaged unnecessarily in an attempt to stabilise fractures that on the whole do not require operative intervention. With these sort of fractures in my practice, I try and keep the patients off them for 1027 8 weeks but even with screws in, the authors are keeping their patients touch weight bearing for 4 weeks. I believe that many of these operations that are being carried out may be unnecessary. Martin D. Bircher* Fairways, The Warren, Ashtead KT12 2SE, United Kingdom *Tel.: +44 1372 276161 doi:10.1016/j.injury.2006.05.019 LETTER TO THE EDITOR Kirschner wires for Colles’ fracture Sir, I read the article ‘Do Kirschner wires maintain reduction of displaced Colles’ fractures?’ by Barton et al.1 with great interest. I have some queries for the authors on the article. 1. The authors are inconsistent in their definition of malunion in terms of radial length in the article. In the introduction they have proposed this to be 3 mm and in the discussion they have mentioned this as 2 mm. If it is 3 mm, as quoted in the literature, then reduction should aim at restoring radial length to within 1.4 mm (instead of 0.4 mm as suggested by authors) to allow a further collapse of 1.6 mm. 2. Contrary to the authors statement there are articles quoting radiological outcome in distal radius fractures fixed with Kirschner wires. In our series of 113 patients2 we found satisfactory radiological outcome in 80% cases. We used Stewart’s grading3 to classify the radiological outcome scoring the radial tilt, dorsal tilt and radial length. We found a mean loss of 8.078 in dorsal tilt in these patients, whereas the authors in this series have observed no loss of dorsal tilt during follow-up. 3. 12 patients had a third K wire in this series, details of which seem to be missing from the article. Were any of these Kapandji wires? If they were, did the authors find any difference in terms of loss of radial length between Kapandji and non-Kapandji groups? The literature suggests that use of Kapandji wires improves radiological outcome in these fractures.4 1028 Letters to the Editor References 1. Barton T, Chambers C, Lane E, Bannister G. Do Kirschner wires maintain reduction of displaced Colles’ fractures? Injury 2005;36(12):1431—4. 2. Kurup HV, Mandalia V, Shaju KA, et al. Variables affecting stability of distal radius fractures fixed with K wires–—a radiological study. Eur J Orthop Surg Traumatol 2005;15(2): 135—9. 3. Stewart HD, Innes AR, Burke FD. Factors affecting the outcome of Colles’ fracture: an anatomical and functional study. Injury 1985;16(5):289—95. 4. Strohm PC, Muller CA, Boll T, Pfister U. Two procedures for Kirschner wire osteosynthesis of distal radial fractures. A randomized trial. J Bone Joint Surg Am 2004;86-A(12): 2621—8. Harish V Kurup* Ysbyty Gwynedd, Bangor, North Wales LL57 2PW, United Kingdom *Tel.: +44 1248384384 E-mail address: harishvk@yahoo.com doi:10.1016/j.injury.2006.05.022 LETTER TO THE EDITOR Origami in dynamic hip screw surgery by J. Auyeung and O Thomas [Injury 2004;35:1039—41] Dear Editor, I write regarding the above article and subsequent correspondence.1—3 I am reminded of a challenge set to me during my basic surgical training days. To clarify, I should state that as well as being an ENT trainee, I am a national expert on origami. Origami is the Japanese name given to the art of paper folding. The art had probably existed since the 7th century and may have originated in China, rather than Japan.4 Ancient origami consisted of folding simple shapes. Modern origami designs use complex computer algorithms to devise folds. Traditionally, origami folds involve a single square, with no cutting. During my days as an orthopaedic SHO in 2001, I was challenged by my supervising consultant, Mr. Richard Rawlins, to design some orthopaedic origami. While not a dynamic hip screw, I devised an origami hip replacement (Figs. 1 and 2, enclosed).5 DOI of original article: 10.1016/j.injury.2003.12.010. Figures 1 and 2 femur. An origami total hip replacement and For those who know anything about folding, the prosthesis was from a single box-pleated base, and the femur was adapted from a kite base.