The Hip: Preservation, Replacement and Revision

Phalangeal Frx Intraosseous Wires

- See: Phalangeal Frx

- Indications:
    - open transverse phalangeal fractures, replantation;
    - certain transverse phalangeal fractures, avulsion & intra-articular fractures;

- Advantages:
    - allows fixation of small intra-articular frx fragments;
    - there is no transfixation of soft tissues, which is seen w/ multiple K wire fixation;

- Technique:
    - involves passage of stainless steel loop of wire (26 gauge) across fracture line dorsal to the midaxis and insertion of oblique K wire to neutralize rotational forces;
    - prior to fracture reduction, a 0.042 inch K wire is driven obliquely across frx;
    - make 2 drill holes w/ K wire parallel to & 5 mm from the frx ends, dorsal to mid axis of bone;
    - 26 gauge (No 0) stailless steel wire is passed thru the holes & twisted;

- Type A Intra-osseous Wiring:
    - utilizes 26 guage stainless steel wire and 0.035 inch wires;
    - indicated for arthrodesis or transverse phalnageal frxs;
    - the interosseous portion of the wire runs parallel to the frx line;
    - the wire provides for rotatory and lateral angulatory control;
    - wire insertion technique:
              - a 0.035 K wire is used to drill two holes parallel to the frx (or joint line);
              - holes are located 5 mm to the frx site, slightly dorsal to the midline;
              - wire is inserted and loop is made on non-contact side of digits;
                     - do not tighten down the loop until the K wire is iserted;
    - K wire fixation:
              - in the proximal phalanx a dorsal midline incision is utilized;
              - because the intra-osseous wire does not provide AP stability, a single 0.035 inch K wire is passed across the frx site, either obliquely (securing two cortices) or longitudinally down the frx site;
    - wire tightening:
              - wire is tighten down in usual manner;
              - end of wire loop is placed into a cortical hole made by the K wire;

- Type B Wiring:
    - indicated for intra-articular fractures;
    - cortical holes are made at right angles to the fracture site so that the wires cross the frx line, wrap around the frx fragment, and allow direct compression;
    - first reduce the fracture w/ reduction clamp;
    - subsequently drill parallel holes at right angles across the frx sites, and then the No. 0 wire is passed thru the path made by the K wire;
             - consider use of a 20 gauge needle into the drill hole to facilitate passage of the monofilament wire

Intraosseous Wiring of the Digital Skeleton.

Tension wire fixation of avulsion fractures in the hand.

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

Last updated by Data Trace Staff on Thursday, October 4, 2012 12:56 pm