The pins are versatile and are generally useful for internal fixation. A pin has a relatively small diameter and is inserted through soft tissue and bone with a relatively small trauma. A Kirschner cable with an electric drill and a guide system is inserted. Soft tissues tend to wrap around the Kirschner wire at the time of insertion and should always be protected. Several types of guides are used: a telescopic guide linked to the drill or an external guide with a handle are common orthopedic instruments. An electric drill with a quick locking and releasing mechanism saves considerable time and is also suitable for the insertion of the Kirschner wire from the drill barrel, which also serves as a guide.
Kirschner Wire Insertion
• Always deploy an electric drill to insert a Kirschner cable.
The cable is bent once it is inserted into a manual drill.
• To protect soft tissues during insertion, always use a guide to direct the pin.
• Cut
- Support the cable.
- Place the cutting jaws at right angles to the cable.
- Bend the cable up after cutting.
• The tip of the cable must not touch the plaster.
Form a point: 2 oblique cuts to make a sharp point
Provisional Fixation
Kirschner wires are useful for the provisional fixation of a comminuted fracture. They help in the precise placement of orthopedic fragments and implants, especially bone plates and screws. Multiple cables are inserted without any additional trauma. When provisional stability is reached, X-ray images can be taken to visualize the strength and weakness of the construction.
Planning is necessary when inserting Kirschner wires for provisional fixation. The pins are introduced in such a way that they do not obstruct the final placement of the definitive implants. For example, the cables are passed parallel to each other in the same direction in which the tension screw is to be inserted so that there is no obstruction to the compression of the fracture with the tension screw.
Final Fixation
Whenever a Kirschner wire is used for final fixation, the end of the pin must be cut one centimeter under the skin and can be bent; A long cable end will protrude through the skin, either from the pressure from inside or outside. If a cable is cut too close to the bone, it is difficult to locate when removing it. The jaws of a wire cutter are always placed at right angles to the wire. If placed at any other angle, a torsional force develops while the cable breaks. This force is transferred to the bone and, due to this involuntary fracture, it can occur in a small bone, specifically in the spongy area. A sharp point can be fabricated in the firing of the pin by making an oblique cut and then turning the pin to make the second oblique cut. The free end of the cable should always be bent with an orthopedic instrument. The flexural force, if transmitted to the bone, can cause an inadvertent fracture; This complication is avoided by grasping and stabilizing the pin when bending it. There is a genuine danger of migration of a straight pin to soft tissues or bone; It is known that a pin travels a great distance through the soft tissue planes. When a pin is worn around the shoulder, it is imperative that the trip bends.
A pin enclosed in a plaster should not touch the plaster, but move freely inside. There is considerable movement between the plaster and the bone due to the presence and thickness of the soft tissues. If any pin touches the plaster, the forces are transferred to the bone, resulting in loosening of the pin and loss of fixation. A pin must be removed after it has served its purpose.
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