- 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