Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/2.1

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1 Preparation top

Timing of treatment

Active intervention is only required if, at the time of admission, the separation of the physis is still mobile.


Instruments and implants

It is recommended to use 1.0 or 1.2 mm K-wires.

The following equipment is needed:

  • K-wires (1.0 or 1.2 mm)
  • Drill (in case K-wires are not inserted by hand), preferably oscillating to avoid thermal injury, or a T-handle for manual insertion
  • Wire cutting instruments
  • If necessary, contrast medium for arthrography


As most of this epiphyseal fragment is cartilage and the wires are transphyseal, manual insertion with a T-handle is recommended.


Pearl: If a T-handle is not available the K-wire can be bent into a U-shape and manually inserted (see illustration).


Anesthesia and positioning

For children, general anesthesia is always recommended. Muscle relaxation is not necessary.

The patient is placed supine with the arm draped up to the shoulder.

2 Technique top


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.


Splint application

A long-arm splint is applied with the elbow at 90°.

v1.0 2016-12-01