Other techniques in hand fracture treatment
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K wires/Casting?Splinting
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Other techniques in hand fracture treatment
- 1. OTHER TECHNIQUES OF FRACTURE FIXATION & GENERAL CONSERVATIVE MANAGEMENT OF HAND FRACTURES DR JACQUELINE TAN HEAD & SENIOR CONSULTANT DEPT OF HAND & RECONSTRUCTIVE MICROSURGERY SINGAPORE GENERAL HOSPITAL
- 2. OUTLINE • K Wires – Indications & Use • External fixators – Indications & Use • Principles of Non-operative Treatment • Conservative Management of Hand Fractures
- 3. K WIRES • Indications • Primary : Percutaneous fixation of unstable, closed fractures • Secondary : Internal fixation of operatively treated fractures • Transverse, oblique, spiral, longitudinal
- 5. CMCJ FRACTURE DISLOCATION E.G. BENNETT’S Johnson, Van Niekerk & Ouwens, Dartee et al Segmuller
- 6. IPJ FRACTURE DISLOCATION Courtesy of Robert Yap
- 7. LCTeoh. Surgery of the Injured Hand. Chap 33
- 8. PROS & CONS • PROS • Easy to apply • Inexpensive • Different sizes available • Minimal dissection • CONS • Lacks rigidity, requires external support • Pin tract infection • Can distract a fracture • Can loosen and migrate
- 9. EXTERNAL FIXATOR • Indications • Soft tissue injury/loss • Restore length for highly comminuted fractures • Significant loss of bone stock • Infection/non-union
- 11. PROS & CONS • Pros • Easy to insert • Minimal dissection and devascularization of soft tissue and bone • Preserves bony length • Allows access to bone and soft tissue care • Cons • Pin tract infection • Osteomyelitis • Overdistraction • Nonunion • Neurovascular injury • Fractures through pin holes • Loosening
- 13. DISPLACED ARTICULAR FRACTURE? • Fix or not? • Aims of treatment? • Surgical concerns? • Available options?
- 14. ARTICULARLY PLACED INTERFRAGMENTARY SCREW FIXATION JSTan, LCTeoh. JHSA 2011
- 15. PRINCIPLES OF NON-OPERATIVE MANAGEMENT Anatomical and Functional stability • Radiographically – minimal angulation and displacement in 2 planes • Clinically – painless, AROM > 50% Deformity • Some angulation may be functionally acceptable • Malrotation is almost never acceptable
- 16. CONSERVATIVE MANAGEMENT • Stable fracture pattern without gross deformity • Prevent fracture displacement & promote recovery
- 17. CONSERVATIVE MANAGEMENT • Usually isolated, closed fracture • Resting splint & frequent interval active ROM • Requires close supervision • Secondary intention bony healing takes more than 6 weeks
- 18. REDUCTION TECHNIQUES • Principle - Reverse deforming forces • Gravity-assisted • External fixator • Reduction clamps • Special maneuvers, eg Jahss
Editor's Notes
- This fracture should not be managed conservatively In a study with 26 year follow-up, all patients had diminished mobility and strength Persistent subluxation present in 13/17 patients Osteoarthritic changes common
- Can be applied percutaneous
- Percutaneous insertion Direct manipulation of fracture avoided IP joint stiffness due to various factors Magnitude of the soft tissue injury Pins impaling the dorsal apparatus, Intra-articular nature of the injuries
- The surgical treatment of intra-articular fractures is aimed at obtaining perfect articular surface congruency and stable fixation that would allow early mobilization. Metaphyseal collapse – need for bone graft? Small chondral fragments – risk of devascularisation
- The screws were inserted through the articular surface and the screw heads countersunk to about 1 mm under the cartilage surface. Direction of the screws was targeted as perpendicular as possible to the fracture line as could be visualized. The size of the fracture fragment should be 3 times the diameter of the screw for interfragmentary fixation to be possible.
- Careful and skilled monitoring against the need for surgery early (surgical window) Large part of ROM recovered at 3-6 weeks
- Displaced fracture reduced < 1mm gap, no step off or rotation May need traction and strapping
- Proximal phalanx fracture Distal phalanx fracture