6. A fine clamp is used to dissect gently down to bone
to avoid damage to neurologic and vascular structures.
7. Once the clamp is on bone, two Ragnell retractors are used to
retract the tendons to either side of the radius. A small key elevator
is used to clean an area of bone for the pin cannulas.
8. BONE
Bone is visualized at the base of the incision, confirming
that there is no danger to the superficial radial nerve or
other structures.
10. After the hole is drilled, the inner cannula is removed
and the pin is placed through the outer cannula.
11. To determine the location of the second pin,
a pin clamp is used.
12. After both proximal pins are placed, fluoroscopy
confirms the appropriate length.
13.
14. The distal pins are placed into the second metacarpal. The mark on the
metacarpal indicates the first pin, placed near the base of the second
metacarpal. The second pin is placed distal to this using a pin clamp as a
guide to its location.
15.
16. The forearm after the two sets of pins are placed.
The connecting rods are applied to the frame, then
the initial reduction is performed.
17. The initial reduction is performed by flexing the elbow,
slightly supinating the forearm and pulling gentle traction.
18. The frame is then tightened in this position and
radiographs are obtained with 10 degrees of
angulation in each direction.
23. While the fragment is being held in place, a K-wire can
be driven across from the styloid into the fragment,
holding it in a reduced position.
24.
25. Allograft bone or other bone graft substitute may
be introduced into the dorsal defect at this point.
26. Clinical picture of the external fixator and percutaneous pin in place.
It is important at this time to test that full flexion of the MP and IP
joints is possible, as well as motion of the thumb, confirming that
none of the tendons are impinged and that there is not overdistraction
of the carpus.
