Arthrography is indicated when the fragment cannot clearly be identified.
No force is necessary to realign the epiphyseal fragment with the shaft. Forceful maneuvers could damage the physis.
Insertion of first K-wire
The first K-wire is inserted directly through the skin into the fragment from very distal on the lateral side.
Before passing the fracture line, check that alignment of the fragment to the metaphysis is adequate. The K-wire is advanced into the metaphysis (by hand or with a drill).
Insertion of second K-wire
It is recommended to also insert the second K-wire from the lateral side. However, this wire is inserted more obliquely.
If the second K-wire is inserted from the medial side, it is recommended to visualize the insertion point with a small incision. This is to decrease the risk of damaging the ulnar nerve and ensures an appropriate insertion point.
The K-wires are bent and cut outside the skin.
4. Postoperative care
A posterior splint is applied
If the child remains for some hours/days in bed, the elbow should be elevated on pillows to reduce swelling and pain.