Dr. Aaron Wey, MD Preference & Supply Program
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Closed Reduction & Percutaneous Pinning (CRPP)

TYPICAL PROCEDURES

Supracondylar humerus fractures · lateral / medial condyle fractures · distal radius and forearm fractures · phalangeal and metacarpal fractures · distal femoral physeal, and tibial fractures. Any pediatric fracture amenable to closed reduction with percutaneous wire.

CPT / PROCEDURES
Supracondylar / transcondylar humerus — percutaneous pinning24538
Humeral condyle (lateral or medial), with manipulation24582
Distal radius / epiphyseal separation — percutaneous25606
Metacarpal fracture — percutaneous, each bone26608
Phalangeal shaft fracture (proximal/middle), percutaneous, each26727
Distal femur (condyle / supracondylar / physeal) — percutaneous27509
Tibial shaft — percutaneous (e.g., pins)27756
Note 24538 is the supracondylar workhorse. Use the open-treatment codes on Card 2 if an incision is needed to achieve or hold the reduction.

CORE PHILOSOPHY

  • Extremely lean setup; most cases are upper extremity.
  • No routine suction or Bovie unless specifically requested.

DRAPING & POSITIONING

  • Single down sheet (half sheet or 3/4 drape).
  • Pack of blue towels · towel clamp x1.
  • Upper-extremity hand drape with a very small pediatric fenestration — avoid a loose, oversized fenestration.
  • Radiolucent plexiglass arm/hand board for fluoro-guided upper-extremity work.
  • Large C-arm image intensifier positioned (flipped) for efficient AP/lateral imaging; plexiglass cover over the intensifier face so pins do not strike it.

EQUIPMENT

  • Small battery power drill (Stryker or equivalent).
  • Wire collets: small and large for K-wires and Steinmann pins.
  • Splint / cast cart in the room.

OPEN INSTRUMENTS

Open these sets — click for the full tray list
Percutaneous Pinning (CRPP) Setup
  • Pin cutter · K-wire cutter.
  • Heavy wire / cable twister needle driver.
  • Metal Frazier 12 Fr suction tip — used for bending K-wire tips, not for suction.
  • Bolt cutters available for larger Steinmann pins.

IMPLANTS — SMOOTH K-WIRES & PINS

  • All K-wires & pins: sterile, individually packaged, ~9 in length, double-diamond point (diamond on BOTH ends), smooth (non-threaded). Primary order source: STERIS — double-diamond, 9 in, 6 per tube (shop.steris.com; requires a STERIS customer account # to purchase). Equivalent alternates: gSource (double-diamond, sterile) · Zimmer Biomet / DePuy Synthes.
  • 2.0 mm (0.078 in): WORKHORSE — this is a Steinmann pin, not a K-wire. Keep well stocked. STERIS KI71600 (Steinmann pin, double diamond, 9 in, 6/tube).
  • 1.6 mm (0.062 in): STERIS KI71213 · 1.4 mm (0.054 in): STERIS KI71214. Smaller (1.25 / 1.1 mm) available for small hands / digits.
  • 2.2 mm (0.087 in) & 2.4 mm (0.094 in): available for larger bone / older kids.
  • Supracondylar default — open 3 K-wires, 2.0 mm each, unless I specify otherwise.
  • Larger pins: up to 4.0–5.0 mm Steinmann pins available.
  • Rubber pin covers / caps — cap every exposed wire & pin end. Aspen Oxboro (sterile, latex-free): yellow 101001PBX for K-wires (0.028–0.062 in); blue 101002PBX (0.078–0.125 in); red 101003PBX for larger Steinmann (0.141–0.188 in). Stock all three sizes.

DISPOSABLES / LOCAL

  • Xeroform small packets · 4x4 gauze pack · Specialist cotton-blend cast padding, 3 in (BSN 9043; 2/4/6 in = 9062/9044/9046).
  • 22-gauge 3-inch needle · 10 cc syringe.
  • 0.25% plain Marcaine / bupivacaine for postoperative local injection.