Name:
Percutaneous K-wire of Paediatric Supracondylar Humerus Fracture
Description:
Percutaneous K-wire of Paediatric Supracondylar Humerus Fracture
Thumbnail URL:
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/7d6176fa-a265-487c-bb46-650a0e6ce8e8
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/7d6176fa-a265-487c-bb46-650a0e6ce8e8/Percutaneous K-wire of Paediatric Supracondylar Humerus frac.mp4?sv=2019-02-02&sr=c&sig=gz4hACElUkDQtiB5lPpyELIUC5Z31rb%2B6T6SqCQHb5k%3D&st=2024-11-23T10%3A11%3A36Z&se=2024-11-23T12%3A16%3A36Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello today, I'm going to show you a surgical technique of k-wire fixation of supracondylar fracture in a kid. These fractures are extremely common in 5 to 7 year age group. Today's patient is a 4 and 1/2 year old girl who unfortunately fell and has got a type III supracondylar fracture.
So if you see this is completely displaced, this is going posteriorally and medially. So this is posterior medial type of supracondylar fracture, which will be gartland type C. So I'll take you through how to do a close k-wiring for these injuries. So I'm now in the positioning of the patient, the kids are usually small. If you keep them at the head, top of the table, this arm won't be lying on the hand table.
So the key is to have the kid way across on the site of injury. So that you can get a good X-ray while doing this procedure. So our patient is on this side. So CR will come from the opposite side and the screen will be there in the front so that we can see it all the time when we are reducing it and when we are passing the wire. So now we are ready.
The patient is prepped and draped. I never use a tourniquet. One thing you want to examine is you feel here to see if there is any. You feel the bone or if there is puckering of the skin. That means the fracture fragment has gone through the brachialis. In that case, you will have to milk it to dislodge it before you attempt any reduction.
So for this operation, the most important aspect is to get a good reduction. So the first type of a good reduction in order to dislodge the fragment is first along it with the fraction. So my assistant, Dr. Cushman, is applying cone protection and I am applying flexion and I can feel dislodgement of the fracture fragments. And once this is done, you do it for a few minutes and then take an AP X-ray to see if it is reduced in coronol plane.
So after applying traction, you see, there is improvement in its position, but still there is still some room for improvement in terms of reduction in coronal plane. So next step in reduction is now this is still slightly post remedial. So I'm just going to reverse the forces and see if it makes slightly better. So I'm just trying to correct the coronal plane deformity in the same position.
So I'm just trying to push the proximal fragment slightly medially and let's see if it makes any difference. So now you can see after reversing the forces, the reduction is much, much better. So now I'm in a position to start flexing the elbow in order to correct the deformity in sagittal plane. So to correct the deformity, you put the hand on the olecranon and then flex and put on it the hand.
So after pronation we are ready to take a tangential or Jones view. But the key at this stage is don't hyper flex, if you hyper flex then you can damage the posterior periosteum and it can make it unstable. And also, if you hyperflex the ulnar nerve supracondylar blocks anteriorly, and it can be in your way. So let's take a Jones view and see how it looks. So this is the Jones view.
Just to explain, this is the lateral supracondylar ridge. This is medial supracondylar ridge. This is the fracture fragment. So still there is medial displacement of distal fragment in comparison to the lateral side. So if you look at the Jones view, if it is nicely reduced, this is how you will see nice contour of medial supracondylar ridge, lateral supracondylar ridge. However, now whatever we are seeing on the view, I showed the medial, the distal fragment is gone medially.
So all I'm going to do is to push this fragment inside and this slightly outside. The books will describe that you have to do this in extension. But one thing that I will tell you, if you flex it, then the posterior structures are tight and you can translate it millimeter by millimeter. So just apply a little force and you will see slowly this is aligning well. So the key is that you correct residual coronal plane deformity when the elbow is in flexion, not in extension.
So just I'm pushing with my thumb and gently I'm translating the distal fragment slightly lateral.
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