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Ann R Coll Surg Engl. 2009 September; 91(6): 518–519.
PMCID: PMC2966212
Technical Notes and Tips
Bruce Campbell, Section Editor

A Novel Adjunct to Closed Manipulation and Insertion of K-Wires to Paediatric Supracondylar Elbow Fractures

BACKGROUND

Supracondylar fractures of the distal humerus are a common injury sustained by children. Displaced fractures are often treated with closed manipulation and K-wire insertion.1 This report describes a technique designed by MA Bari where an additional K-wire may be inserted to aid reduction.

TECHNIQUE

The patient should be prepared as for a standard manipulation and insertion of K-wires. Closed manipulation should attempted. If this is not successful in restoring anatomy, the additional K-wire may be inserted as described below. A 2-cm incision should be made over the medial epicondyle with the elbow extended and deepened to the bone with meticulous attention to preservation of the ulna nerve. A 2-mm (1.6 mm in young children) K-wire should then be inserted from medial to lateral (under X-ray control) passing through the trochlea and through the capitellum. It should then be passed out through the skin to provide a bar: this can be used to provide both traction and torque to the distal fragment allowing reduction to be easily achieved. Once satisfactory reduction is accomplished, traditional crossed K-wires should be passed using the 2-cm wound used for the medial K-wire. The transverse K-wire is now removed leaving the fracture held by the two standard K-wires.

DISCUSSION

The transverse K-wire is used both as a traction pin and a joystick to provide a useful tool in the reduction of these fractures allowing more accurate reduction of the fracture, and closed reduction of fractures that would traditionally require open reduction.

Figure 1
Transverse K-wire in situ.
Figure 2
Final X ray with transverse K-wire removed.

Reference

1. Marquis CP, Cheung G, Dwyer JSM, Emery DFG. Supracondylar fractures of the humerus. 2008;22:62–9.

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England