The Use of a Kirschner Wire in The

8/2/2019 The Use of a Kirschner Wire in The

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The following case report describes a simpletechnique for closed reduction of a severelycomminuted maxillary fracture withshattering of the dentoalveolar process.

Combination of a rigid external distractorhalo frame on a skull, a kirschner wirethrough the maxilla, and an intermaxillary

wire fixation resulted in stable vertical andsagittal correction of the fragmented maxilla.

Keywords : Kirschner wire, Le fort I fracture, RED halo frame


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The growth in popularity of bicycling in recent

years is reflected in the number of cycling-

related oral and maxillofscial injuries.

The treatment of choice for Le Fort I fracture is

open reduction and internal fixation withminiplate.

Our patient to be difficult and complex due to

the unstable, polyfragmented character of the

fracture with shattering over the dentoalveolar

process of the maxilla.


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Option to treat the patient head frame and

kirschner wire.


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A 61y.o man (GCS 15/15) Bicycle fall with impact of the

face on pavement

No significant past medicalhistory

Loss of consciousness with amnesia (+)

Cognition (N) No airway obstruction

Pain (+) : neck, chest, face


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Upper-lip laceration Multiple facial fractures

Dental trauma

Injury of cervical vertebrae Multiple bruises on the face

Epistaxis (+)

Laceration on the left side mucosa labial-> sutured (+)


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CT scanCervical spine-> fracture without displacement lateral

mass C2

-> Fracture proc. Spinosus C4-C5-> Teardrop fracture C7

Thoracic-> Fracture anterior border of first rib-> Lung contusion


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Maxillofacial-> Frac. Comminuted Le Fort I

-> Frac. Nose

3 D Axial view Coronal view


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ICU ( 4 days )

-> Neurosurgical

- Hard neck collar (Conservative)

-> Thorax-Cardiovaskuler

- Conservative


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-> Plastic surgical (2 days after)

- GA

- Nasoendotracheal tube -> endoscope

1. Intermaxillary fixation ->

Ehrich bars + wires

2. Rigid external distractor (RED) +

K-wire


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K-wire placed transcutaneously thick

anterior portion of palatal bone 3 mmfrom incisive foramen


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RED II distractor Martin -> fixed 3 screw

on each side to the skull and stabilized

with K-wire to the vertikal rod of the

RED frame


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Panoramic radiograph

Anterior + Lateral cephalometric Ro CT maxillofacial

Followed postoperative every week


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After 6 weeks -> intermaxillary

fixation + collar neck removed

1 year after post op -> oral opening

(N) + occlusion (N)


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30% of all maxillofacial and skull base

fracture related to sports injuries

(Elhammali et al)

Concomitant injuries associated with

maxillary fracture were laceration +

abrasion (Haug et al, 1990)

In isolated craniomaxillary fracture ->

cervical spine injury 4.9-8.0 %(Mulligan)


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3.6% patient with craniomaxillofacial

fracture showed a concomitant cervical

spine injury (Elahi et al, 2008)

The majority of injuries to the cervical

spine caused motor vehicle accident,

alcohol use.

Cervical spinal injuries most commonly

occurred at C1-C2 + C6-C7


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Comminuted maxillary fracture using

bone graft reconstruction

Use head frame in fracture- rare in modern practice

- cumbersome

- disliked

- compensate bone loss

- to stabilize unstable fracture

- rehabilitate occlusion + vertical

height


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In this case use a head frame combination

with a K-wire to obtain stabilization of

the comminuted fracture.

For a experience surgeon only 15 minutes

to total operative time

Intermaxillary fixation time in this case

was 6 weeks


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Traumatic dental, maxillofacial and

cervical injuries common in bicyclist

The treatment of choice in comminuted

maxillary fracture is internal fixation +

miniplate + bone graft reconstruction ->

difficult and complex

Alternative treatment Kirschner wire +

head frame -> minimal invasive + good

result


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The Use of a Kirschner Wire in The

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