Optimal K-Wire Placement for Indirect Cannulated Screw Fixation of Coronoid Process Fractures: A Radiology-Based Guide

Philipp Egenolf; Michael Hackl; Tim Leschinger; Andreas Harbrecht; Nadine Ott; Lars P Müller; Kilian Wegmann

doi:10.1016/j.jhsa.2022.10.007

Optimal K-Wire Placement for Indirect Cannulated Screw Fixation of Coronoid Process Fractures: A Radiology-Based Guide

J Hand Surg Am. 2022 Nov 15:S0363-5023(22)00608-6. doi: 10.1016/j.jhsa.2022.10.007. Online ahead of print.

Authors

Philipp Egenolf¹, Michael Hackl², Tim Leschinger², Andreas Harbrecht², Nadine Ott², Lars P Müller², Kilian Wegmann²

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany. Electronic address: philipp.egenolf@uk-koeln.de.
² Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany.

PMID: 36400651
DOI: 10.1016/j.jhsa.2022.10.007

Abstract

Purpose: Indirect fixation of coronoid process fractures of the ulna, especially arthroscopically, offers the possibility to avoid extensive medial surgical approaches. However, optimal placement of K-wires for cannulated screw fixation is technically challenging. The aim of the present study was to present guide values for K-wire placement for indirect screw fixation of coronoid tip (COT) and anteromedial facet (AMF) fractures of the ulna.

Methods: Computed tomography scans of the elbows of 197 patients with an uninjured ulna were identified and evaluated following a standard measuring protocol. Optimal placement of K-wires was defined as the bisector between the anterior and articular cortex while respecting a 1.6-mm safe zone for each placement. This placement of the K-wires in the COT and the AMF was analyzed by measuring the wire angulation in relation to the posterior ulnar cortex (AUC), the distance from the entry point to the posterior olecranon edge (DPE), and the intraosseous length (IOL). Because the coronoid has a curved shape, measurements of the COT and AMF were expected to differ significantly. Sex was also expected to influence measurements. To determine whether this optimal placement of K-wires can be reliably identified, interobserver and intraobserver reliabilities were evaluated.

Results: To address tip fragments, we determined a mean AUC of 64°, DPE of 36 mm, and IOL of 38 mm. Regarding wire placement toward the AMF, the means for the AUC, DPE, and IOL were 79°, 27 mm, and 33 mm, respectively. Statistically significant differences were found between the COT and the AMF for the AUC, DPE, and IOL. Our measuring protocol showed good interobserver and intraobserver reliability.

Conclusions: K-wire placement toward the COT demands a smaller angle, a longer IOL, and a more distal entry point than wires placed toward AMF. These differences reflect the curved and complex anatomy of the coronoid.

Clinical relevance: This measuring algorithm can be used to plan osteosynthesis, and the obtained reference values can help understand the coronoid's complex anatomy.

Keywords: Anteromedial facet; K-wire; coronoid process; coronoid tip; screw fixation.