AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Method of choice for middle phalanx fractures
Long consolidation time for fracture
Allows early ROM of PIP and DIP joints
Multiple planes
For oblique fractures
Pins perpendicular to fracture resist bending, torsion, and distraction
Pins placed perpendicular to fracture resists compressive load
Intramedullary nailing Gonzalez, et al. J Hand Surg 20A, 1995
Multiple pre-bent 0.8 mm are passed proximally to distally thru drill holes made near the MP joint
2-3 rods are placed into the proximal phalanx and end at the subchondral bone distally
rod is cut flush with the bone proximally
hand is placed in a dorsal MP blocking splint for 4 weeks and begins immediate PIP motion
results
average angulation 2∞,
worst 12 lateral angulation,
4∞hyperextension
average AROM of PIP 89∞
4 pts. with flexion contracture of PIP joint, worst 20
TAM 238∞, (191∞ –269∞)
Long oblique fracture
Definition - fracture whose length is twice the diameter of the bone at the fracture site
When closed reduction possible:
Hold reduction with percutaneous reduction clamp
Insert multiple K-wires perpendicular to the bone and fracture
Insert > 2 lags screws, each separated by 2 head diameters
Phalangeal neck fracture
May occur at middle or proximal phalanx
Phalangeal head is hyperextended
Failure to treat leads to permanent loss of flexion
Technique
Place K-wire longitudinally thru distal phalanx
Hyperextend distal bone thru IP joint to capture head of fractured phalanx
Reduce fracture by inserting pin down the shaft of the broken phalanx
Complications
Pin tract infection
Reported as high as 18% Botte, et al, Clin Orthop, 276, 1992
No tension should be present at pin exit site
Infection more likely when patient splinted and motion at pin site allowed
Flexion contracture
More likely when fracture is near PIP joint
More likely with soft tissue disruption
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