Proximal Phalanx Frx: Percutaneous Intramedullary K Wire


- See: proximal phalangeal fractures:

- Disscusion
    - indicated for unstable frx of base, shaft, and neck;
    - K wire characteristics:
          - use 0.035 or 0.045 inch wires, depending on the size of the phalanx
          - 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;


- Technique:
    - reduction:
             - note that the proximal phalanx has a natural dorsal apex curve and that any K wire IM technique will have a tendency to straighten out
                     the phalanx (which tends to give a volar apex deformity);
             - apply longitudinal traction across the PIP joint as the MP joint is flexed to 60 deg and the PIP joint is flexed to 45 deg;
             - ensure that that clinically there is no rotational deformity, and then confirm frx reduction w/ flouroscopy;
    - fixation:
             - trans-MP joint fixation:
                     - most indicated for fractures proximal to the midline;
                     - allows early PIP joint motion (which is the joint that tends to remain most stiff post op);
                     - MP joint is flexed to 60 deg, and insert a percutaneous K wire longitudinally across metacarpal head to pass down the meduallary canal of the proximal phalanx to
                              end just shy of the subchondral surface of the condyle;
                              - ensure that the wire is inserted along one side of the extensor tendon, through the metacarpal head (to pass across the MP joint);
                     - becuase this technique is technique is difficult, consider initial retrograde K wire insertion thru the distal phalangeal condyle (requires maximal PIP
                              joint flexion during insertion), which is then driven across the flexed MP joint;
                              - the K wire is then pulled proximally until its end clears the distal condyle;
             - in the reprot by Hornbach, et al, the authors report the results of 12 unstable extraarticular fractures of the proximal
                     phalanx treated with transarticular intramedullary Kirschner wires;
                     - early proximal IP joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°;
                     - excellent results were observed in ten of the 12 patients;
                     - ref: Closed Reduction and Percutaneous Pinning of Fractures of the Proximal Phalanx.
               - w/ distal neck frx, consider insertion of 2-3 0.028 inch intramedullary K wires;
             - wires may be best inserted down the medullary canal by hand w/ use of T handle device;

                     


- Post Op:
    - well padded dressing is then applied to protect the pin sites, but it is important that there remains some PIP motion;
           - PIP motion will help to impact frx fragments;
    - generally, cast is left on for 3 weeks



 Closed Reduction and Internal Fixation of Proximal Phalangeal Fractures.

Percutaneous screw treatment of spiral oblique finger proximal phalangeal fractures.



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

Last updated by Data Trace Staff on Monday, June 4, 2012 11:17 am