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 through a small lateral stab incision into the fragment from distal to proximal.
Before passing the fracture line, the reduction of the fragment to the metaphysis is checked using image intensification. The K-wire is then advanced into the metaphysis.
Insertion of second K-wire
A second oblique lateral K-wire is recommended.
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.
A long-arm splint is applied with the elbow at 90°.
3. Postoperative care
The postoperative protocol is as follows:
Time in hospital according to local practice (1-3 days)
First clinical and radiological follow up, depending on the age of the child, 2-3 weeks postoperatively out of the cast
In most cases, at this first x-ray control, the fracture is consolidated and stable so that the cast is no longer required and the K-wires can be removed