Hypodermic needle to guide Kirschner-wire placement in paediatric supracondylar humerus fractures: a technical trick

PURPOSE: Supracondylar humerus fractures are among the most common injuries in the paediatric population, accounting for 16% of all paediatric fractures and roughly 60% to 70% of all paediatric elbow fractures. Typical treatment for displaced and unstable supracondylar humerus fractures is surgical intervention, often with percutaneous Kirschner-wire (K-wire) fixation. Timing of surgery is dependent on the patient’s neurovascular status on presentation, with surgical emergencies being performed at all hours of day and night. Percutaneous fixation of paediatric elbow fractures can be challenging as a result of the propensity for the elbow to become quite swollen with these fractures, particularly in smaller and physiologically more immature elbows. METHODS: We have developed a simple operative technique to guide placement of percutaneous wires for supracondylar humerus fractures using a hypodermic needle as a reference marker. RESULTS: In our experience, trainees utilizing this technique demonstrate greater appreciation for start point and trajectory of wires during percutaneous pinning, with better communication amongst surgical team members about necessary adjustment for optimal placement of K-wires. CONCLUSION: Utilization of this technique has the potential to refine surgical technique by minimizing errant wire passes, radiation and operative time when performing percutaneous pinning of reduced type III supracondylar humerus fractures. LEVEL OF EVIDENCE: V, Novel Surgical Technique