Fractures of the proximal part of the
proximal phalanx are often unstable and angulate
percutaneous fixation may not provide adequate purchase
on the proximal
fracture fragment. These images show a method
of increasing stability of percutaneous fixation in this
situation by placing additional pins into the proximal
fragment and incorporating these into an external
fixation framework. The metacarpophalangeal joint
capsule is entered with the pins, but the pins do not
engage the metacarpal head.
|Click on each image for a larger picture|
Case 1.A malaligned three week old fracture. Notice the typical zig zag collapse pattern resulting in flexion of the proximal interphalangeal joint to the same degree as the fracture angulation.
|Manipulation and closed reduction:|
|Percutaneous pins placed across the fracture line and also dorsal to palmar into the proximal fracture fragment.|
|The pins were left protruding through the skin, and were bent toward each other to form a common zone of overlap which was glued together with aquaplast to form an external fixation construct.|
technique, the hand is immobilized in a protective
position splint for four weeks. Immediately before pin
Case 2.Unstable dorsal and laterally angulated proximal phalanx fracture in an elderly osteopenic woman.
|Closed reduction and insertion of interfragmentary and proximal fracture fragment pins.|
|Pins were bent to
overlap and then bonded with heated thermoplastic
|Four weeks postop,
immediately prior to pin removal in the office.
percutaneous fixation phalanx
proximal phalanx fracture
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