Percutaneous pinning of supracondylar fractures: A simple modification in technique to minimize growth plate damage

Supracondylar fracture of humerus is one of the common pediatric fractures encountered by an orthopedic surgeon. Closed reduction and percutaneous pinning is one of the recommended treatments for displaced-supracondylar fracture of humerus. The growth plate of distal humerus in the pediatric age group is a relatively small area and drilling Kirschner (K)-wires across the physes will cause physical, thermal, and vascular damage to it. It is a very common scenario where a K-wire is drilled multiple times to achieve acceptable position and the damage to the growth plate gets added with every new attempt and is further compounded as the number of K-wires required to achieve stability increases. Thus, we may achieve a good reduction and a stable fixation but still cause irreversible damage to the growth plate and end up with resultant deformity. We suggest a simple modification in the pinning technique by using a bone marrow aspiration needle to act as a guide and sleeve. This technique helps in reducing the number of attempts required to achieve acceptable position of the pins thereby reducing above-mentioned iatrogenic damage to the physes. It not only prevents soft tissue injury by acting as a sleeve but also gives mechanical advantage during passage of thin diameter K-wire in small children. It can also be used to find the proximity of ulnar nerve by stimulating it, thereby reducing the chance to damage the nerve during medial pinning.