70.12 Skeletal traction with Kirschner wires

These are thin flexible stainless steel wires 0.75 to 1 mm in diameter. Use them for. applying traction: (1) Through the heads of the metacarpals in open forearm fractures. (2) Through the olecranon in comminuted fractures of the lower humerus, or when the patient must lie supine. Kirschner wires are thin and flexible, so you must drill them in, and you can only apply traction to them with an expensive tensioner, such as the Gissane stirrup which will hold them taut. Unlike a Steinmann or Denham pin, where movement takes place between the pin and the pin mount, movement with Kirschner wire traction takes place between the wire and the tissues. This limits the amount of exercise that is practical. Kirschner wires can only be used if they are straight, and because they always bend in use, you cannot use the bent parts again, although you may be able to cut off the straight parts which remain and reuse them.

KIRSCHNER WIRE TRACTION

Sharpen the wire on a stone to a chisel or a triangular point as in Fig. 70-12. Cut it to length with a pair of pliers.

Drill it in with a hand drill (Fig. 70-12)- Use the chuck to hold the wire near the end. In the softer bones of children, you may be able to put it in with pliers.

OLECRANON For some comminuted supracondylar fractures when the patient must lie supine. insert the wire from the medial to the lateral side, taking care to avoid his ulnar nerve.

METACARPALS For open or comminuted fractures of the radius and ulna. Insert the wire through the second and third metacarpal from the medial to the lateral side, avoiding the fourth and fifth metacarpals which are more mobile and lie anteriorly. Metacarpal bone is hard, and drilling may be difficult. Don’t go too far anteriorly, or you may injure the patient’s digital vessels and nerves. Some surgeons claim that metacarpal traction is seldom necessary and prefer skin traction on all the four fingers, while watching the circulation of the fingers with care!

CALCANEUS Kirschner wire traction is an alternative to a Steinmann pin for fractures of the tibia.

DRESSINGS These are the same as for Steinmann pins.