Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/2.1

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Glossary

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.


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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

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


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


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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

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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.


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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.


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Insertion of second K-wire

A second oblique lateral K-wire is recommended.


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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.


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The K-wires are bent and cut outside the skin.


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Splint application

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

v1.0 2016-12-01