K wires are commonly used in orthopedic surgery to fixate small bone fractures and dislocations. They were introduced in 1909 and are made of stainless steel or nickel titanium alloy. K wires are inserted using fluoroscopic guidance to stabilize bone fragments while allowing early range of motion. Proper technique and wire placement is important to avoid complications like loss of fixation, infection, or stiffness.

1. K WIRE FIXATION-BASICS
Dr. AKSHAI GEORGE PAUL

2. Introduced in 1909
by Martin Kirschner,
the wires are now widely
used in orthopedics.
He introduced it as SS (Stainless Steel) Wires

3. • Initially K wires are Pins not wires
• Other than Smooth bK wires now a days using
Threaded K wires for Shoulder and Ankle Surgery
• It's Mostly made of SS or NiTi alloy
• Size range from 0.75 mm to 5 mm and Length upto
30 cm

5. Indications
• Fixing Small Bone # and Dislocation
• Transfixing unstable dislocation
• Arthrodesis
• Splint for Soft Tissue Healing
• Deformity and Contracture corrections

6. • Temporary Fixation
• Maintain deformity correction
• Correct malunion, Non Union
• K wire Traction in Illizarov
• Marker used in C arm

8. Size of K wire

12. General Technique
• Appropriate Size to be Taken
• Working length of K wire on Drill bit should not be
Too Long
• Mostly Done under C arm guidance

14. • Feel of Piercing bone and C arm guidance is
Important in reaching K wires at Desired Location
• While bending K wires No force to be Transmitted
to it
• Saline irrigation to be done at site to avoid thermal
necrosis bof Bone

15. • Most cases K wires passed from Free fragment into
main Fragment
• K wire to be entered via a Stab insertion
• Multiple drilling to be mostly avoided
• K removal Mostly done 4-6 wks- Based on the
Check Xray

16. Complications from K wiring
• Loss of Fixation
• Loss of Reduction
• Migration of K wire
• Break of K wire
• Pin tract Infection

17. • Skin teathering
• Stiffness

18. Distal Phalynx # in LF

20. HAND

21. Introduction
• One of the most important methods of fixation of
small bones of hand.
• Stiffness, pain and Deformity are the major
concerns during this treatment.
• One should know the safe corridors to pass K wires,
So that to start active range of motion at the
earliest.

22. • On Table active examination test-To Rule out soft
tissue tethering
• Most cases are done under Digital /Wrist block
• Show the patients the complete range of
movements done by him in OT-Boost patients
confidence to work on post operative
physiotherapy

23. Indications
• Unstable #
• Fractures with rotation and angulation and
shortening
• Multiple phalangeal # in same hand
• Open #
• Avulsion # (Central slip avulsion,Mallet finger)
• Failed conservative management

24. Safe corridor in a Finger
• It is the area in which K wire can be passed with
minimal soft tissue trauma and with out impaling
NVB,Tendons,extensor expansion etc.

25. Proximal Phalanx
1)A Triangular wide area of safe zone is present
dorsolaterally and dorsomedially on either side of
extensor tendon in base of proximal phalanx.
2)PPX shaft is dangerous zone it has ligaments and
NVB in proximity.
3)In PPX Head dorsomedial and dorsolateral small
triangular area is safe in flexion and obliterates in
extension.

26. Middle Phalanx
1)Base-Small triangular safe corridor in flexionof PIPJ
dorsomedially and dorsolaterally between the
central slip and lateral band
2)Shaft-Dangerous area,Lateral band and ORL
3)Head-Wide safe zone dorsomedially and
dorsolaterally in both flexion and extension

27. Distal phalanx
1)Tip – Safe
2)Dorsal and volar insertion points of long flexor and
extensor tendons respectively

28. Safe position of Hand(Intrinsic
Plus hand)

29. • Position of immobilisation should be leads to the
least amount of stiffness and early functional
recovery of the joint
• MCPJ are in 70 degree flexion,PIPJ and DIPJ in full
extension,Thumb in abduction such that collateral
ligaments are at maximum stretched position in
this posture and wrist in 30 degree dorsiflexion

30. DISTAL PHALANX

31. Distal phalanx # In Little finger

32. • DPX # at waist level lead to the flexion of distal
fragment and extension of base,which is caused by
the extensor expansion insertion
• Lead to nailbed disruption and can cause
cosmetically scarred nail if not managed properly

34. • At the point of entry one must spend some time for
a perfect position under C arm guidance before
advancing intramedullary
• Once wrong tract is created, it is literally difficult to
change tract
• Slow advancement with 0.75 mm K wire is ideal

35. Open DPX # Of MF with Closed
Mallet Finger deformity

36. • In the DPX # was transfixed spanning across the
DIPJ in extension for correction of mallet finger
deformity-K wire removed after 6 weeks
• Mallet night splinting was given for another 6
weeks

37. Open distal Phalanx # with Nail
bed laceration

38. • Viability of distal tip to be assessed carefully with
not to injure the healthy digital artery
• In an anterograde manner K wire is inserted into
the proximal part of DPX under C arm guidance

39. DIPJ

40. Mallet Finger with Arthritis-DIPJ
Fusion of MF

41. • Post mallet finger with arthritis treated with DIPJ
fusion
• Fused in 0 degree extension by passing an axial K
wires
• Compression ant arthrodesis site is maintained by 2
cross K wires
• Wires are maintained for 10-12 wks

43. # Dislocation at DIPJ of MF with
Mallet

45. MIDDLE PHALANX

46. Displaced Central slip avulsion #

47. • K wire is passed through small fragment and
manipulated and get a perfect reduction in
extension

48. Central slip avulsion with
Boutonniere Deformity

49. • Joint trans fixation K wire in extension of PIPJ
• Additional K wire to transfix the avulsed fragment
• Movements were started immediate post op

50. Comminuted # Base of MPX with
Volar displacement

51. • K wire is passed from DPX tip intra medullary into
the DPX,DIPJ,MPX,PIPJ and PPX head
• Splaying out of base was avoided by gentle
compression of Comminuted fragment
• With Ligamentotaxis principle Fragments are
arranged in distraction.

52. PIPJ

53. PIPJ dislocation with central slip
avulsion

54. • PIPJ dislocation reduced and maintained by Cross k
wires passed from MPX distal to proximal at PPX
head
• It was left for 4 weeks then vigorous mobilization
started

55. PROXIMAL PHALANX

56. Transverse # Neck of PPX

57. • 2 parallel K wires were passed parallel from PPX
base negotiating the # into the PPX head and
parked subchondrally

58. Long oblique # of Proximal
phalanx

59. • After anatomical reduction # stabilized with 2
oblique K wires passed perpendicular to the #

60. MCPJ

61. Intra articular # base of PPX

62. • K wires must be passed engaging the fragment and
transfixed to the distal fragment

63. METACARPAL

65. • K wiring of MC # from MCPJ is done in a distal to
proximal direction starting from the center point of
entry an intra medullary wire
• Spike jetting out dorsally is clearly visible in the true
lateral view

66. Rolando #-Comminuted intra
articular # base of first MC

67. • Traction, abduction is exerted by the surgeon using
his fingers and thumb
• K wire is introduced into distal fragment using
surgeons other hand parallel to the thumbnail of
the traction hand into the trapezium

68. Bennet #-Fracture subluxation of
First metacarpal base