Kirschner wire migration into intramedullary canal of ulna during open reduction and internal fixation

At Bunbury Regional Hospital, we recently saw a case where Kirschner wires (K-wires), used during open reduction and internal fixation of olecranon, were propelled down the intramedullary canal intraoperatively. The K-wire was only secured unicortically. From our experience, we have developed steps to prevent this complication. First, where the wires are being used as part of a tension band wire construct, we suggest drilling the distal hole prior to the placement of the K-wires and, secondly, where K-wires are being used to secure the fracture fragment, the K-wires can be secured with artery clips to ensure that the wires remain in position.