K-wire fixation

K-wire fixation is indicated in immature animals for a growth plate fracture. It can be used for adult small breed dogs and cats when bone plates are unavailable. In the majority of cases, the ulna is also fractured above or through the growth plate.

The K-wire is inserted in the distal fragment or alternatively, a crossed pin technique can be used, with one K-wire going through the radial styloid process across the fracture and a second one from the ulnar styloid process through the fracture line.

The patient can be in dorsal or lateral recumbency.

In lateral recumbency, the affected leg should be in contact with the table.

A craniomedial approach is used to reduce the fracture. Fixation with K-wires can be achieved through either open or minimally invasive craniomedial and craniolateral portals.

The goal is to achieve anatomical reduction.

The extensor carpi radialis tendon should be elevated and retracted laterally to create room for bone manipulation and plate fixation.

Bone-holding forceps are applied to the proximal fragment. The distal fragment is manipulated by grasping the foot and flexing the carpus while applying traction to achieve reduction.

The fracture ends are elevated, toggled, and placed back into reduction.

Alternatively, the K-wire can be inserted in the distal fragment first and then used as a joystick to achieve reduction.

Appropriately sized K-wires are selected.

As an alternative, crossed pin techniques can be applied. One K-wire is driven from the radial styloid process across the fracture and through the lateral cortex of the radial proximal fragment.

A second K-wire is driven from the ulnar styloid process into the radial epiphysis and then through the fracture line, engaging the medial cortex of the medial proximal fragment.

The exposed ends of the K-wires should be bent to prevent migration and facilitate removal.

A Robert Jones or modified Robert Jones bandage can be applied for 1–3 days to decrease the edema and protect the surgical incision.

The aim is to reduce edema, inflammation, and pain. Integrative medical therapies, anti-inflammatory medications, and analgesics are recommended.

10–20 minutes of ice therapy is recommended every 8 hours in most cases.

The patient can immediately bear weight, but with strict control of activities.

The aim is to resolve hematoma and edema, control pain, and prevent muscle contracture. Anti-inflammatory and analgesic medications may still be needed.

Rehabilitation and integrative medical therapies can be used.

A careful evaluation is recommended if the patient is not starting to use the limb within a few days after surgery.

The sutures are removed 10–14 days after surgery.

Immature patients should be radiographed every 4 weeks.

A radiographic assessment is performed every 4–6 weeks until bone healing is confirmed, more frequent assessment may be necessary for skeletally immature patients.