Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section I - Fractures of the first metacarpal
from Chapter 6
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
KIRSCHNER WIRE FIXATION OF BASAL FRACTURES OF THE FIRST METACARPAL
Indications
Fractures of the base of the first metacarpal tend to dislocate owing to forces from the tendons (e.g. abductor pollicis longus (APL) tendon in Bennett's fracture). Therefore operative treatment is necessary if stable retention cannot be achieved by casting. Closed reduction and internal K-wire fixation can be performed for:
(a) Fractures with small fragments.
(b) Fractures with good alignment after closed reduction but no stable retention without fracture fixation, in the absence of large impression defects.
Pre-operative planning
Clinical assessment
Pain and swelling localized to carpometacarpal joint I.
Assess and document neurovascular status of thumb.
Radiological assessment
Standard anteroposterior (AP) and lateral radiographs of the trapezium (Kapandji) obtained by placing the hand for a true lateral view, with abduction of the thumb and directing the imaging beam centred over the trapeziometacarpal joint.
Computed tomography helps to define the degree of comminution within a fracture, as well as suspected impaction of the articular surface.
Operative treatment
Anaesthesia
Brachial plexus block, intravenous regional anaesthesia or general anaesthesia.
Prophylactic antibiotic according to the local hospital protocol (e.g. 2nd generation cephalosporin).
Table and equipment
Hand surgery instrumentation set, K-wires: 1.2mm.
Radiolucent armtable.
Upper armtourniquet.
Image intensifier.
Table set up
The instrumentation is set up on the side of the operation.
Image intensifier is from the front side of the arm table.
Patient positioning
Supine, supinated armextended on armtable.
Fracture reduction
Gentle axial traction and pressure on the displaced fragment usually reduces displaced fractures.
Open anatomical reduction is indicated if closed reduction fails and/or stable reduction cannot be achieved.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 98 - 103Publisher: Cambridge University PressPrint publication year: 2006