Background
Following open reduction and internal fixation of finger fractures, postoperative stiffness is a potential problem, occurring in up to 51% of cases.1 Stiffness can be significantly reduced by using closed reduction and Kirschner wire (K-wire) fixation,2 although infection is a problem reportedly occurring in up to 18% of cases.3
We describe a simple method for phalangeal fracture (Fig 1) fixation. K-wires are used as a ‘joystick to aid closed reduction and provide temporary stabilisation before being sequentially replaced with low-profile screws through stab incisions.
Figure 1.
An oblique intra-articular fracture of the distal end of the proximal phalanx of the middle finger
Technique
Initial longitudinal traction is applied to disimpact the fracture. A 1.2-mm K-wire is then passed percutaneously in the midaxial plane through one cortex only, which is used as a ‘joystick’ to obtain fracture reduction (Fig 2). Once the fracture has been reduced, the K-wire can be inserted further to engage the far cortex and to provide temporary stabilisation. A second parallel K-wire is then passed.
Figure 2.
K-wires can be used as a joystick to aid closed reduction then sequentially replaced with low-profile screws
When fracture reduction is radiographically confirmed, the K-wires can be sequentially replaced with low-profile headed 1.5-mm screws through stab incisions, which need only to be big enough to pass the screw heads (Fig 3). There is no need to drill, as the track of the K-wires is adequate.
Figure 3.
An example of a restored joint line, held in place with two screws
Discussion
This method is simple to use, provides more compression across the fracture than K-wires alone, with minimal soft tissue damage or periosteal stripping, potentially resulting in a lower risk of infection. The technique provides stable fixation and enables early active mobilisation, reducing stiffness and potentially resulting in improved functional outcome.
References
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