Guide-wire and K-wire readjustment jig for osteotomy and osteosynthesis: An instrument

Abstract

Introduction

Numerous orthopaedic procedures including dynamic hip screw plating and various osteotomies require placement of a reference guide pin or K wire to direct bone cuts or for drilling screw holes. Appropriate positioning of these wires is a critical component of surgery. Irrespective of whether one is a seasoned surgeon or an apprentice, these wires often need repositioning and readjustment. Parallel wire positioning is needed even during procedures like osteotomies or patellar fracture fixation. Though there are several tools available to help with accurate placement of wires and saving operating time, there are very few tools which can actually control the direction or angulation of the wire. The ones which are available are usually difficult to use, are bulky, have long attachments arms or have too many fine adjustments. We propose a device that not only directs the positioning of the parallel wires but also helps with a 360-degree correction in direction of the wrongly positioned wire. It is a multipurpose jig that can be used in patella fracture, inter-trochanteric fracture femur, fracture neck of femur, osteotomies around knee, elbow and distal femur, etc.

Material and methods

We proposed, designed and manufactured a new device for the guide wire insertion. Our jig design has three tunnels. Two tunnels, primary and secondary run parallel to each other and the oblique tunnel runs at an angle and is positioned 7 mm away from the parallel tunnel at one end and shares a common opening with the secondary tunnel on opposite end. Other similar jigs either have only parallel tunnels (primary and secondary) or an oblique tunnel which is at the far end of metal bar, making it difficult to be used to correct the angular direction of the guidewire in reference to primary or secondary wire.

Results and conclusions

Using our newer device, wires can be guided in all directions and in all planes (sagittal, coronal, axial, and 360°). Correction of the wire direction using this jig is significantly easier and faster, a process which can take anywhere between 15 min and an hour of surgical time for a beginner orthopaedic surgeon. The need for multiple repeated attempts to insert wires, resulting in a bone void and damage to the surrounding structures, is minimised or eliminated. Applications include a variety of surgical procedures of osteosynthesis and osteotomies. In conclusion, our device is easier to use as it is smaller in size and available in different sizes and angles. It not only avoids bone loss and fragmentation due to repetitive insertion of wires but also improves the accuracy of primary reference wire placement or revision of its direction.