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Vaslow AS, Deal JB, Ho CA. Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes? J Pediatr Orthop 2023; 43:311-316. [PMID: 36863778 PMCID: PMC10082043 DOI: 10.1097/bpo.0000000000002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. METHODS Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ 2 tests and ANOVA. Two group comparisons were made with Student t test. RESULTS There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan's system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. CONCLUSIONS Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
- Aaron S. Vaslow
- T Brian D. Allgood Army Community Hospital, Camp Humpreys, Pyeongtaek, South Korea
| | - James Banks Deal
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christine A. Ho
- Department of Orthopaedic Surgery, Children’s Health Dallas
- Scottish Rite for Children
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX
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Liu S, Sun B, Wang P, Fu S. Percutaneous pinning with interphalangeal joint locked in phalanx fractures: The surgical technique and the results. Medicine (Baltimore) 2021; 100:e26782. [PMID: 34397826 PMCID: PMC8341342 DOI: 10.1097/md.0000000000026782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of the study was to compare the operation time, the fracture healed time, the postoperative function recovery between the techniques that temporary locking of the interphalangeal joint and traditional manual reduction in the treatment of percutaneous pinning of the phalanx fractures. METHODS Patients with phalanx fractures from January 2015 to January 2018 who were admitted to our hospital were retrospectively reviewed. Patients received surgery with traditional manual or temporary locking of the interphalangeal joint reduction. The information of patients, including age, gender, the length of the operation, the fracture healed time, the postoperative function recovery, complication, and length of postoperative hospital stay, was collected. All of the information were evaluated and compared between the 2 groups. All of the surgery were performed by 2 experienced hand surgeons of our department. The patients in the 2 groups were followed up for an average of 6 months after surgery. RESULTS All patients completed the operation and were followed up completely. There was no significant difference in baseline data between the 2 groups (P > .05). The observation group who received surgery with the interphalangeal joint locked technique had significantly shorter in operative time than the control group (P < .05). And postoperative complications in the observation group were significantly less than those in the control group (P < .05). However, the postoperative functional recovery in both groups was no significant difference between the 2 groups (P > .05). And there were no significant differences in the fracture healed time and length of postoperative hospital stay between the 2 groups (P > .05). CONCLUSION Both surgical techniques can enable patients to achieve good function, but the technique of interphalangeal joint locked is effective in the treatment of the phalanx fractures, as it is characterized by short operations and a quick recovery. However, this technique is only suitable for extra-articular phalanx fractures that the AO/ASIF classification of type A2.3 and less than 2 weeks, not for other phalanx fractures.
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Pientka WF, Cheng J. Percutaneous Fixation of Pediatric Fractures of the Proximal Phalanx Neck: A Novel Technique. Tech Hand Up Extrem Surg 2020; 25:175-182. [PMID: 33239500 DOI: 10.1097/bth.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Proximal phalanx neck fractures occur almost exclusively in children. Fractures of the proximal phalanx neck can be difficult to treat nonoperatively given the anatomic location and associated extrinsic forces. A divergent or crossed pin configuration is often utilized for the stabilization of these fractures. PURPOSE We present a surgical technique with a single Kirschner (K-wire) placed axially along the affected finger, with a hyperextension reduction maneuver, to reduce and fixate proximal phalanx neck fractures in children and adolescents. METHODS We performed a retrospective review of all pediatric proximal phalanx neck fractures treated by a single surgeon. Demographic data, as well as clinical and radiographic outcomes were recorded. We then directly compared axial pinning [14 patients; average age 6.63 y (9 mo to 17 y)] with nonoperative treatment [28 patients; average age 8.03 y (9 mo to 16 y)], and open treatment [8 patients; average age 8.13 y (1 to 14 y)]. RESULTS Patients who underwent closed reduction and axial pinning had significantly improved final coronal alignment compared with nonoperative treatment. Compared with fractures which required open reduction, closed reduction with axial pinning resulted in significantly shorter surgical duration and time to radiographic healing. The final range of motion showed no difference between intervention types, as all patients regained full range of motion. CONCLUSIONS We find this axial pinning technique to be simpler and faster than divergent pin fixation, with no significant differences in time to radiographic healing, time to full activity, final proximal interphalangeal active flexion or extension, loss of reduction, or radiographic parameters. LEVEL OF EVIDENCE Level III-Therapeutic.
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Affiliation(s)
- William F Pientka
- Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX
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Lateral Pinning of the Pediatric Phalangeal Neck Fracture. Tech Hand Up Extrem Surg 2020; 25:116-119. [PMID: 32868695 DOI: 10.1097/bth.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Closed reduction and percutaneous pinning is the treatment of choice for displaced pediatric phalangeal neck fractures. Multiple techniques have been described to address challenges in managing these unstable fractures. We describe our technique of closed reduction and percutaneous pinning, which avoids the physis and increases the wire insertion accuracy, minimizing the number of attempts and wire passes made at percutaneous pinning.
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Zhang X, Shao X, Zhang Z, Zhang G, Yu Y, Wang L, Lyu L. Cemented K-wire fixation for the treatment of shaft fractures of middle phalanges. Injury 2018; 49:351-358. [PMID: 29055495 DOI: 10.1016/j.injury.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/04/2017] [Accepted: 10/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this report is to introduce an external-fixation technique using the combination of K-wires and cement. METHODS From February 2009 to January 2015, 51 patients with shaft fractures of middle phalanges were treated with cemented K-wire fixation. The mean age of patients at surgery was 41 years. The mean time interval from injury to operation was 6±5.78days. Injured digits included index (n=18), long (n=15), ring (n=7), and little (n=11) fingers. Types of fractures were transversal (n=32), short oblique or spiral (n=5), and comminuted (n=14) fractures. Active range of motion of the fingers was measured. Total active motion was scored based on the American Society for Surgery of the Hand. All measurements were compared with those on the opposite fingers. Patients also reported on their satisfaction using the 100-mm visual analogue scale. RESULTS At the final follow-ups of 2 years, range of motion of metacarpophalangeal joint, proximal phalangeal joint, and distal interphalangeal joint reached 97%±2.88, 93%±6.65, and 96%±3.22 of the opposite fingers, respectively. Based on Total active motion scoring system, we obtained 36 excellent and 15 good results. Based on VAS, patient satisfaction was 96±3.44. CONCLUSIONS The cemented K-wire fixation is a reliable technique for the treatment of shaft fractures of middle phalanges. The technique is a minimally invasive procedure with minimal complications. LEVEL OF EVIDENCE Therapeutic study, Level IVa.
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Affiliation(s)
- Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China.
| | - Xinzhong Shao
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Zheming Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Guisheng Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China.
| | - Li Wang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
| | - Li Lyu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, China
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Comparison Between Buddy Taping With a Short-Arm Splint and Operative Treatment for Phalangeal Neck Fractures in Children. J Pediatr Orthop 2017; 36:736-42. [PMID: 25955173 DOI: 10.1097/bpo.0000000000000521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Phalangeal neck fractures in children are difficult to treat conservatively because of the difficulty in maintaining reduction, obtaining satisfactory follow-up x-rays, and the limited remodeling potential. The purpose of this study was to present the results after using buddy taping with a short-arm splint for phalangeal neck fracture in children and to compare with operative treatment. METHODS Thirty-seven patients below 12 years old who had phalangeal neck fractures were included. Nineteen patients were underwent conservative treatment and 18 patients were underwent operative fixation with Kirschner wires. Clinical outcome and radiographs between groups were compared. RESULTS There were no significant differences between conservative group and operative group in the sagittal angulation, coronal angulation, and translation at immediately after reduction, at the 6-week, and final follow-up examination. CONCLUSION Buddy taping with a short-arm splint for treating phalangeal neck fractures had acceptable outcomes compared to that with surgical correction.
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Naik AA, Hinds RM, Paksima N, Capo JT. Risk of Injury to the Dorsal Sensory Branch of the Ulnar Nerve With Percutaneous Pinning of Ulnar-Sided Structures. J Hand Surg Am 2016; 41:e159-63. [PMID: 27137081 DOI: 10.1016/j.jhsa.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the risk of injury to the dorsal sensory branch of the ulnar nerve (DSBUN) with percutaneous pinning of commonly stabilized ulnar-sided structures. METHODS Eleven fresh-frozen cadaveric upper extremities were assessed. Percutaneous pinning of the fifth metacarpal base and neck, lunotriquetral joint, ulnar styloid, and distal radioulnar joint (DRUJ) with 1.4-mm Kirschner wires was performed under fluoroscopic guidance. Each specimen was then carefully dissected and the distance from each pin to the DSBUN was measured using a digital caliper. Direct injury to the DSBUN and pins found immediately adjacent to the nerve were recorded. RESULTS Mean distance from the pin to the DSBUN at the fifth metacarpal neck was 5.0 ± 1.5 mm; fifth metacarpal base, 2.3 ± 2.2 mm; lunotriquetral joint, 1.8 ± 1.6 mm; ulnar styloid, 0.8 ± 1.1 mm; and DRUJ, 3.1 ± 0.9 mm. Two of 11 ulnar styloid pins and 1 of 11 lunotriquetral pin directly penetrated the DSBUN, whereas 4 of 11 ulnar styloid pins, 3 of 11 fifth metacarpal base pins, and 2 of 11 lunotriquetral pins were directly adjacent to the DSBUN. There was an increased overall risk of DSBUN injury (risk of direct injury and risk of adjacent pin) with pinning of the ulnar styloid compared with fifth metacarpal neck and DRUJ pinning. CONCLUSIONS The current study demonstrates the risk of iatrogenic injury to the DSBUN with percutaneous pinning of the ulnar styloid, lunotriquetral joint, and fifth metacarpal base. CLINICAL RELEVANCE We recommend identifying and protecting the nerve to mitigate the risk of iatrogenic injury when performing ulnar-sided pinning of structures from the ulnar styloid to the fifth metacarpal base.
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Affiliation(s)
- Amish A Naik
- Division of Hand Surgery, New York University Hospital for Joint Diseases, New York, NY.
| | - Richard M Hinds
- Division of Hand Surgery, New York University Hospital for Joint Diseases, New York, NY
| | - Nader Paksima
- Division of Hand Surgery, New York University Hospital for Joint Diseases, New York, NY
| | - John T Capo
- Division of Hand Surgery, New York University Hospital for Joint Diseases, New York, NY
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Cheah AEJ, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations. J Hand Surg Am 2016; 41:712-22. [PMID: 27113910 DOI: 10.1016/j.jhsa.2016.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/22/2016] [Indexed: 02/02/2023]
Abstract
Hand fractures are the second most common fracture of the upper extremity, and management of patients with these injuries is common for most hand surgery practices. In this article, we outline the principles of management of these injuries with a special focus on those that are common or complex. We also highlight recent innovations in the context of these injuries. From this cross-section of contemporary evidence on phalangeal and metacarpal fracture treatment, we have noted a trend toward minimally invasive surgery with immediate postoperative mobilization, the use of wide-awake anesthesia, as well as sustained investigation and innovation in the biomechanics and treatment of proximal interphalangeal joint fracture dislocations.
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Affiliation(s)
- Andre Eu-Jin Cheah
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA; Department of Hand and Reconstructive Microsurgery, National University Hospital, National University Health System, Singapore
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA.
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Abstract
Seymour fractures are open juxta-physeal fractures of the distal phalanx. A true lateral radiograph should be obtained for diagnosis, and treatment should include removal of the nail, irrigation and debridement of the fracture, and percutaneous Kirschner wire stabilization. Mallet fractures are more common in children than adults, and treatment is generally nonoperative for nondisplaced or minimally displaced fractures without volar subluxation of the distal phalanx; however, splinting compliance should be carefully assessed in younger populations. Phalangeal neck fractures have a limited potential to remodel and a propensity to redisplace. A true lateral radiograph will show displacement best; treatment is generally with percutaneous pinning. Open reduction should be avoided when possible because of the risk of osteonecrosis of the phalangeal condyles. The epidemiology of scaphoid fractures in children is changing, with waist fractures now the most common type. This may be due to an increase in body mass index (BMI) as well as high-level sports participation in today's pediatric population. Although the vast majority of acute scaphoid fractures can be treated successfully with cast immobilization, children who present with established nonunions should be offered open reduction and internal fixation as the primary treatment.
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Affiliation(s)
- Parker B Goodell
- UC Davis School of Medicine, 2101A Education Building, 4610 X Street, Sacramento, CA 95817
| | - Andrea Bauer
- Boston Children's Hospital, HUN 213, 300 Longwood Avenue, Boston, MA 02115
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Al-Qattan MM, Al-Munif DS, AlHammad AK, AlFayez DI, Hanouneh S. The outcome of management of "troublesome" vs "non-troublesome" phalangeal neck fractures in children less than 2 years of age. J Plast Surg Hand Surg 2015; 50:93-101. [PMID: 26542090 DOI: 10.3109/2000656x.2015.1106408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several authors have indicated that there are specific poor prognostic factors which may affect the outcome of management of phalangeal neck fractures. In the authors' centre, phalangeal neck fractures with any of these poor prognostic factors are labelled "troublesome". Any of the following five criteria will qualify the fracture to be regarded as "troublesome": concurrent vascular compromise of the fractured digit, open/partial amputation injuries, comminution of the fractured phalangeal head, concurrent epiphyseal or juxta-epiphyseal fractures distal to the fractured phalangeal head, and all Type III fractures (as per Al-Qattan classification). METHODS The effect of these poor prognostic factors has not been investigated in the youngest paediatric age group; the hands of whom are known to be most forgiving. The purpose of this study is to compare the outcome of management of seven "troublesome" vs nine "non-troublesome" phalangeal neck fractures in children less than 2 years of age. Demographic data (age, sex, fracture site/type, and troublesome factors) were reviewed for the 16 cases. All patients were treated according to a specific protocol, and the outcome was documented using a modified Al-Qattan's outcome grading system. RESULTS Of the nine children with non-troublesome fractures, eight obtained a satisfactory outcome and the ninth case had an unsatisfactory outcome. In contrast, all seven children with troublesome fractures had an unsatisfactory outcome and the difference was highly significant (p = 0.0007). CONCLUSION The authors strongly advise discussing the outcome of troublesome fractures with the parents and also advise documenting this in the file (prior to management) for medico-legal reasons.
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Affiliation(s)
- Mohammad M Al-Qattan
- a Division of Plastic Surgery , King Saud University , Riyadh , Saudi Arabia and
| | - Dina S Al-Munif
- a Division of Plastic Surgery , King Saud University , Riyadh , Saudi Arabia and
| | - AlAnoud K AlHammad
- a Division of Plastic Surgery , King Saud University , Riyadh , Saudi Arabia and
| | - Dalal I AlFayez
- a Division of Plastic Surgery , King Saud University , Riyadh , Saudi Arabia and
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Al-Qattan MM, Al-Qattan AM. A review of phalangeal neck fractures in children. Injury 2015; 46:935-44. [PMID: 25766097 DOI: 10.1016/j.injury.2015.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 02/02/2023]
Abstract
Phalangeal neck fractures are uncommon and are almost exclusively seen in children. Most paediatric hand fractures are treated conservatively and an excellent outcome is expected in almost all cases. Paediatric phalangeal neck fractures are different mainly because they are unstable and have a high risk of complications. Even minimally displaced phalangeal neck fractures are known to be unstable following reduction and hence k-wire fixation is required. Furthermore, complications such as persistent deformity, nonunion, and avascular necrosis are commonly seen following management of phalangeal neck fractures; such complications are extremely rare in other paediatric hand fractures. The current paper aims to review the diagnosis, classification, management and complications of these fractures in children. The paper also aims to introduce an extended classification of phalangeal neck fractures and to explain the clinical relevance of the extended classification.
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Affiliation(s)
| | - Ahmed M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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Pelissier P, Recanati G, Alet JM. In-out-in pinning for phalangeal fractures. ACTA ACUST UNITED AC 2014; 34:24-6. [PMID: 25540910 DOI: 10.1016/j.main.2014.10.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Abstract
Although a commonly used technique, percutaneous pinning of phalangeal fractures is tricky because of the difficulties associated with getting the correction pin orientation when entering the medullary canal of one fragment from the outer cortex of the other fragment. This has led us to develop the "in-out-in" pinning technique. The principle consists of entering the medullary canal of one of the fragments directly from the fracture site. The pin is inserted and drilled outward through the outer cortex. The second pin is inserted in the same manner. The fragments are then aligned and the pins pushed forward in the medullary canal of the other fragment.
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Affiliation(s)
- P Pelissier
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.-X. Michelet, CHU de Bordeaux-Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - G Recanati
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.-X. Michelet, CHU de Bordeaux-Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J-M Alet
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.-X. Michelet, CHU de Bordeaux-Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Dhamangaonkar AC, Patankar HS. Antegrade joint-sparing intramedullary wiring for middle phalanx shaft fractures. J Hand Surg Am 2014; 39:1517-23. [PMID: 24855966 DOI: 10.1016/j.jhsa.2014.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/13/2014] [Accepted: 04/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcome for surgical stabilization of middle phalanx shaft fractures with joint-sparing antegrade intramedullary K-wire fixation. METHODS We treated 15 extra-articular transverse or short oblique shaft fractures of the middle phalanx in 13 patients. All fractures were treated with closed reduction internal fixation with antegrade joint-sparing intramedullary K-wires. Patients had a minimum follow-up of 1 year (range, 1-10 y). We assessed the objective outcome at 6 months by calculating total active range of motion. RESULTS All fractures healed. Based on the total active motion score at 6 months, 10 digits showed excellent results, 3 digits were good, 1 was fair, and 1 was poor. Among 3 patients with an associated flexor tendon injury, 2 had excellent outcomes and one had a poor outcome. For 2 patients with an associated extensor tendon injury, 1 had a good outcome and the other had a fair outcome. CONCLUSIONS Antegrade intramedullary wiring for extra-articular transverse and short oblique shaft fracture of middle phalanx is a simple, safe, inexpensive, and joint-sparing technique that provides enough fracture stability, even in cases of associated injuries, for early rehabilitation and functional recovery with the expectation of a good to excellent outcome. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Hemant S Patankar
- Patankar's Hand and Limb Reconstruction Clinic, Mumbai, Maharashtra, India.
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15
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Gregory S, Lalonde DH, Fung Leung LT. Minimally invasive finger fracture management: wide-awake closed reduction, K-wire fixation, and early protected movement. Hand Clin 2014; 30:7-15. [PMID: 24286737 DOI: 10.1016/j.hcl.2013.08.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We prefer wide-awake finger fracture reduction, closed percutaneous K-wire fixation, and early protected movement to treat phalangeal fractures. This approach allows intraoperative visualization of active movement after K-wire fixation with the possibility of adjustments during the case. It also negates the need for extensive dissection with subsequent scar formation between the tendons and the bone. It provides the same advantages that are provided by early protected movement after flexor tendon repair.
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Affiliation(s)
- Sol Gregory
- Department of Plastic Surgery, University of British Columbia, 899 West 12th Avenue, Vancouver, British of Colombia V5Z1M9, Canada
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[Intramedullary fixation of displaced middle phalangeal neck fractures]. ACTA ACUST UNITED AC 2013; 32:287-91. [PMID: 24080201 DOI: 10.1016/j.main.2013.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 06/06/2013] [Accepted: 07/22/2013] [Indexed: 11/22/2022]
Abstract
Middle phalanx neck fracture is an unusual injury. In order to prevent malunion and stiffness, a surgical treatment is usually recommended. Owing to the distal localization of the fracture, internal fixation is demanding. Open reduction can further damage the soft tissues and the bone itself, resulting in stiffness or condylar necrosis. The bulk of plate and screws can interfere with the extensor apparatus and transarticular or cross K-wires may damage the joint surfaces or ligaments. An intramedullary pinning technique is reported minimizing these pitfalls. The technique is described and illustrated by two clinical cases with good result.
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