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.