Clinical Example: Percutaneous fixation of proximal fracture of the proximal phalanx

Fractures of the proximal part of the proximal phalanx are often unstable and angulate dorsally. Longitudinal 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 fracture 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.
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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.
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Intraoperative fluoroscopy.
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Manipulation and closed reduction:
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Percutaneous pins placed across the fracture line and also dorsal to palmar into the proximal fracture fragment.
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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.
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With this technique, the hand is immobilized in a protective position splint for four weeks. Immediately before pin removal.
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Case 2.
Unstable dorsal and laterally angulated proximal phalanx fracture in an elderly osteopenic woman.
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Closed reduction and insertion of interfragmentary and proximal fracture fragment pins.
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Pins were bent to overlap and then bonded with heated thermoplastic splint material.
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Four weeks postop, immediately prior to pin removal in the office.
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