From the Research
K-wire fixation for a supracondylar humerus fracture in a 9-year-old boy involves a specific surgical procedure to stabilize the fracture and promote proper healing, with the most recent and highest quality study 1 suggesting that closed reduction technique is preferred due to less hospitalization time and almost no visible surgical scars. The procedure begins with the patient receiving general anesthesia and being positioned supine with the affected arm on a radiolucent table.
- After sterile preparation and draping, closed reduction is performed by applying traction, correcting medial/lateral displacement, and restoring the normal carrying angle while confirming alignment with fluoroscopy.
- Two to three K-wires (1.6-2.0 mm diameter) are then inserted percutaneously, with the first wire placed from the lateral epicondyle across the fracture to engage the medial cortex of the proximal fragment.
- A second wire is inserted from the lateral side in a similar but divergent pattern for stability, and if needed, a third medial wire may be added for additional support.
- Wire placement is verified with fluoroscopy in multiple views to ensure proper fracture reduction and wire positioning. The wires are then cut outside the skin, bent, and covered with sterile dressings, and a long-arm posterior splint or cast with the elbow flexed at 60-90 degrees is applied for additional immobilization. Post-operatively, the patient requires regular follow-up at 1-2 weeks, with K-wires typically removed at 3-4 weeks once radiographic healing is evident, as supported by the study 1. This technique is preferred because it provides stable fixation while minimizing the risk of neurovascular injury and growth disturbance in the pediatric patient, with the study 1 showing no significant differences in outcomes between open and closed reduction methods. Key considerations in the procedure include:
- Proper positioning and imaging to ensure accurate reduction and wire placement
- Careful handling of the wires to avoid neurovascular injury
- Regular follow-up to monitor healing and remove the K-wires at the appropriate time
- The use of a long-arm posterior splint or cast to provide additional immobilization and support during the healing process.