70.13 Kirschner wire for bone fixation

Kirschner wire fixation is useful for some severe hand injuries and in some fractures of the olecranon. If you put a short piece of Kirschner wire through two pieces of bone it will keep them aligned, but it is less successful in preventing them coming apart. The easiest way to prevent this happening is to bind the fragments in place with soft stainless steel wire. This is most effectively done by drilling a hole, through the bone, passing the wire through the hole and then looping it in a figure of eight around the bent ends of the pieces of Kirschner wire as in Fig. 72-26. This is Kirschner wire hemicirclage, and is an AO method; it is the most practical way of fixing those fractures of the olecranon (72.18) which must be fixed internally.

INTERNAL FIXATION WITH KIRSCHNER WIRE

INSERTION If you are going to fix a fragment with Kirschner wire alone, use two wires in slightly different planes, avoiding the plane at right angles to the fracture plane.

Use wire cutting forceps to bend over the outer 3 mm of the wires. These bent ends will be easier to find and remove later if necessary; they will not pierce the skin, and they can be used to anchor soft wire for hemicirclage.

Drill the bone and thread soft stainless steel wire thorugh it, as in Figs. 72-26, 79-8, and 75-9a.

CAUTION! Don’t leave Kirschner wire sticking out of the skin, because this increases the chances of infection.

REMOVAL If the wire is causing no trouble, leave it. If the ends of the wire are painful under the skin, or if there is infection, or a sinus, remove it. Feel for the end of the wire under the skin and take it out under local anaesthesia. Make a nick in the skin and remove it with bull nosed pliers filed to a sharp point, or with any convenient instrument. If you cannot find the end of the wire, you may have to give the patient a general anaesthetic and remove it after first applying a tourniquet.