K-wire fixation provides less stability than ESIN fixation. It needs additional cast or splint immobilization to prevent elbow movement during healing causing elbow stiffness. Other potential disadvantages include infection and cross-union.
This treatment may be used for reduction and fixation of a radial head that is severely displaced or if an image intensifier is not available.
2. Instruments and implants
The following equipment is needed:
K-wires of appropriate sizes
Drill or a T-handle for manual insertion
Wire cutting instruments
Standard orthopedic instrument set
3. Patient preparation
This procedure is normally performed with the patient in a supine position.
The K-wires must provide adequate spread at the fracture site on any view.
If the K-wire spread is inadequate, the fixation is likely to be rotationally unstable.
Pitfall: The K-wires should engage the far cortex but not protrude into the soft tissues.
Confirm the position of the K-wires on both AP and lateral views.
If the position is inadequate, adjust the K-wires.
Trimming of K-wires
Whether the K-wires are left outside the skin or cut and buried beneath the skin depends on the surgeon’s preference.
K-wires may be left protruding, but there is a risk of pin-track infection. The advantage is that the K-wires can be removed without anesthesia.
Close the wound in layers with resorbable sutures.
Final radiological documentation
Take standard x-rays in lateral and AP view.
7. Additional immobilization
K-wire fixation alone confers minimal stability. Additional immobilization is required to reduce the risk of secondary displacement.
Immobilize the arm in 90° flexion of the elbow with a cast or a splint to prevent elbow movement.
8. Aftercare following K-wire fixation and immobilization
Duration of immobilization
Radial head and neck fractures usually require 3-4 weeks of cast immobilization for adequate callus formation.
Ibuprofen and paracetamol should be administered regularly during the first 24-48 hours after surgery, with opiate analgesia for breakthrough pain.
Opiates should not be necessary after 48 hours and regular ibuprofen and paracetamol should be sufficient until 4-5 after injury or surgery.
The child should be examined if the level of pain is increasing or prolonged analgesia is needed.
The child should be examined after casting/splinting, to ensure finger range of motion is comfortable and adequate.
Neurological and vascular examination should also be performed.
Compartment syndrome should be considered in the presence of increasing pain, especially pain on passive stretching of muscles, decreasing range of active finger motion or deteriorating neurovascular signs, which is a late phenomenon.