Innovative Callus Release Technique for Closed Reduction in Old Fractures: Case Studies and Methodology.

BACKGROUND In modern limb fracture management, particularly in children, image-guided closed reduction and percutaneous fixation are commonly employed. However, for older, displaced fractures, achieving closed reduction may be challenging or even unfeasible, often necessitating open reduction, which carries a higher risk of complications. We utilized K wires to fragment the fibrous callus and facilitate callus fragmentation in 2 patients with old fractures. In both cases, successful fracture reduction was achieved using a closed technique, followed by percutaneous K wire fixation. CASE REPORT Patient 1 was a 10-year-old girl who presented 10 days after sustaining a fully displaced fracture of the left radial neck due to trauma. Closed reduction under general anesthesia was unsuccessful. We employed percutaneous K wires to fragment the fibrous callus at the fracture site, enabling successful reduction and subsequent fixation. Patient 2 was a 50-year-old woman who presented with a displaced fracture at the base of the proximal phalanx of the little finger, initially treated with closed reduction and cast immobilization. At a follow-up examination 2 weeks later, the fracture was found to be fully displaced. Attempts at closed reduction under ring block anesthesia were unsuccessful. A percutaneous K wire was utilized to fragment the fibrous callus, enabling successful reduction and fixation. CONCLUSIONS The technique of fibrous callus fragmentation and closed reduction, followed by percutaneous K wire fixation, offers an effective approach for managing neglected, displaced fractures of the radial neck and the proximal phalanx of the little finger. This method allows for closed reduction and internal fixation in these challenging peri-articular fracture locations.