Crossed K-wires are a simple way of holding a fracture, but accurate single pass insertion is required to cause the least tissue trauma.
It is often helpful to plan the path of the wire by resting a wire on the skin and imaging it. The wires should cross a distance away from the fracture site and have sufficient purchase in the fragments on either side. If possible, avoid transfixing the adjacent joints especially the PIPJ.
Flexing the MCPJ and PIPJ provides stability. Use the tip of the wire to find the indent distal to the flare of the metacarpal head. The entry point is checked (with imaging) and then drive the wire along the line of the skin marking.
Tip: Check AP and Lateral views as you proceed using Image intensifier/C-Arm to avoid multiple passes from adjustments. Don’t be fooled by an excellent image in one plane (e.g.AP view). The other view (lateral) may reveal the wire is not even in the bone.
This process is repeated for the second wire.
* No children were harmed while taking these photographs.