- Discussion:
- K wires should never cross at the fracture site, since this will
cause rigid distraction;
- K wires should cross either proximal or distal to the fracture and gain firm
anchorage in the proximal and distal metaphysis;
- Holding Power of the Wires:
- increased penetrating ability and holding power with trocar tips, when
compared to diamond tips;
- increased holding power w/ lower drilling speeds;
- Indincations:
- unstable phalangeal fractures;
-
Metacarpal Fractures involving isolated shaft, neck, or base frx;
- Technique for Proximal Phalanx Fractures:
- apply longitudinal traction & flex MP joint to 80 deg & PIP to 45 deg;
- for transverse frxs, place K wire (0.045 inch) on metacarpal head (to one
side of extensor tendon) & drive wire down shaft until wire reaches
subchondral bone in head of the phalanx;
- Phalangeal Neck Fractures:
- may be unstable & may need 2 or 3 0.028 inch K wires;
- Oblique Fractures:
- reduction of
spiral and
oblique fractures is maintained w/ pointed
reduction clamp;
- 2 or 3 0.28 inch K wires are inserted across fracture perpendicular to
long axis of phalanx & engage both cortices of the phalanx;
- wires should be placed as far as possible from each other along
length of the fracture line;
----------------------------
Extension block pinning for proximal interphalangeal joint fracture
dislocations: preliminary report of a new technique.
Complications of smooth pin fixation of fractures and dislocations in the
hand and wrist.
