1 Introduction topenlarge
Note: Be aware of nonaccidental injury in infants.
Careful scrutiny of the x-rays is important to identify the presence or absence of a metaphyseal component, as this may be the only radiologically visible sign of a corner/bucket handle fracture.
2 K-wire fixation topenlarge
A small skin incision is made directly over the ulnar styloid.
The incision is deepened to the bone using a blunt artery forceps and a protective sleeve is inserted.
Care should be taken to avoid damage to the dorsal sensory branch of the ulnar nerve.
A single 1.6 mm smooth K-wire is inserted into the detached styloid fragment and used as a joystick to achieve reduction under direct vision.
The wire should be inserted using a T-handle.
Once reduction is satisfactory, the K-wire is advanced until it just engages the radial cortex of the distal ulnar metaphysis.
Ideally, the K-wire is inserted under image intensifier control to check the trajectory of the wire and to ensure engagement of the far cortex without penetration into the soft tissues.
The K-wire is left protruding through the skin, bent and cut. The skin is protected with sterile padding prior to the application of a cast.
The illustration demonstrates the use of a small section of plastic tubing over the cut ends of the protruding wires. This adds further protection for the skin.
Note: Excessive pressure between dressing and skin should be avoided to prevent skin necrosis.
3 Short arm cast topenlarge
The purpose of the cast is protective and for pain relief, as stability is provided by the K-wire.
The short arm cast is applied according to standard procedure:
Note: In young, small, or noncompliant patients, it is safer to apply a long arm cast.
Splitting of cast
If a complete cast is applied in the acute phase after injury, it is safer to split the cast down to skin over its full length.