Percutaneous intramedullary elastic wiring of displaced diaphyseal forearm fractures in children. A modified technique.

Under the age of 11 years there are specific anatomic considerations which favour intramedullary wiring of displaced forearm fractures. The isthmus of radius and ulna is narrow (range = 3-6 mm). The medulla is at its widest proximally in the (ulna) and distally in the radius. These are the optimum entry points for intramedullary progression of the wire. At these points there is a low stress raising effect minimising the risk of iatrogenic fracture. A 1.6 mm Kirschner wire is elastic enough to be prebent into a large radius. It is strong enough to resist deformity on entry, though elastic enough to achieve stability by intramedullary three-point contact. The tip of the wire is prebent to 30 degrees aiding closed reduction of displaced fractures. An oblique 4.5 mm drill hole is made through a < 2 cm skin incision avoiding the epiphysis. This allows the wire to be introduced into the intramedullary canal at an optimum angle of 30 degrees. A smaller hole would not allow intramedullary progression e.g.; in a 2.5 mm hole the angle of insertion would be 55 degrees. Wire is now held with a cannulated T-handle, which is tapped with a hammer thus bouncing the wire of the side wall into the medulla. Rotating the handle aids reducing of displaced fractures. There are advantages to this method over other methods of intramedullary fixation e.g.; Steinman pins, Rush pins, or Nancy nails. Also holds advantage over plating. Over the last 12 months 11 cases were treated by the above methods without significant complications.