Abstract
A modification is presented to a commonly used type of improvised external fixator for hand fractures. Our modified fixator is easy to apply and allows fracture manipulation in three dimensions after application, before the cement sets.
Keywords: Fracture, External fixation, Ex fix, Hand Fracture
The value of external fixation in the hand is well established [1–3]. Commercially available external fixators [4, 5] are not always suitable or available, and several improvised external fixators have been described, although these may be limited in size or position if made using short [6, 7] tubes.
A popular technique is to use a syringe barrel or rigid plastic tube filled with orthopaedic cement [7, 8]. Pairs of Kirschner wires (K-wires) are passed through the syringe after being inserted into the bones proximal and distal to the fracture.
This techniques has drawbacks because the tubing is brittle. Drilling the wire through the syringe before it enters the bone blunts the tip, but it is difficult to attach the syringe to the wires once they are positioned in the bone without causing loosening. It is also difficult to distract or position the fracture fragments once the fixator is attached, making it difficult to correct rotational, angular or linear displacement of the fracture.
We replace the syringe with a length of corrugated anaesthetic tubing, which is easily available in any hospital (Fig. 1). The tubing is flexible and soft walled, so the reverse ends of K-wires can be passed through it easily once the wire is already inserted into the bones. Once sufficient wires (at least two either side of the fracture) have been inserted, the tube is filled with cement. The construct can be manipulated to the desired position before the cement sets, allowing reduction of the fracture and correction of angular, longitudinal or rotational deformity before providing rigid fixation once the cement hardens (Figs. 2 and 3). It is the ability to manipulate the construct before it hardens that is the major advantage of this improvised device, and we have found it to remain stable during fracture healing.
Fig. 1.
Short length of anaesthetic tubing (the connector is removed prior to use)
Fig. 2.
Postoperative photograph showing the external fixator in situ
Fig. 3.
Radiograph taken seven days postoperatively showing stability of the construct
References
- 1.Hastings H, Ernst J. Dynamic external fixation for fractures of the proximal interphalangeal joint. Hand Clin. 1993;9(4):659–674. [PubMed] [Google Scholar]
- 2.Parsons SW, et al. External fixation of unstable metacarpal and phalangeal fractures. J Hand Surg (Brit) 1992;17B:151–155. doi: 10.1016/0266-7681(92)90077-f. [DOI] [PubMed] [Google Scholar]
- 3.Riggs S, Cooney W. External fixation of complex hand and wrist fractures. J Trauma. 1983;23:332–336. doi: 10.1097/00005373-198304000-00011. [DOI] [PubMed] [Google Scholar]
- 4.Fahmy R, Harvey R. The “S” Quattro in the management of fractures in the hand. J Hand Surg (Brit) 1992;17B:321–331. doi: 10.1016/0266-7681(92)90122-i. [DOI] [PubMed] [Google Scholar]
- 5.Schuind F, Cooney WP, 3rd, Burny F, An KN. Small external fixation devices for the hand and wrist. Clin Orthop Relat Res. 1993;293:77–82. [PubMed] [Google Scholar]
- 6.McCulley SJ, Hasting C. External fixator for the hand: a quick, cheap and effective method. J Royal Coll Surgeons Edinb. 1999;44:99–102. [PubMed] [Google Scholar]
- 7.Thomas RK, Gaheer RS, Ferdinand RD. A simple external fixator for complex finger fractures. Acta Orthop Belg. 2008;74:109–113. [PubMed] [Google Scholar]
- 8.Godwin Y, Arnstein PM. A Cheap, disposable external fixator for comminuted phalangeal fractures. J Hand Surg (British and European Volume) 1998;23(1):84–85. doi: 10.1016/S0266-7681(98)80227-1. [DOI] [PubMed] [Google Scholar]