ORIF of Hand Frx w/ K Wires


- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, October 4, 2012 12:49 pm