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Section III - Fractures of the phalanx

from Chapter 6

Published online by Cambridge University Press:  05 February 2015

Peter V. Giannoudis
Affiliation:
St James's University Hospital, Leeds
Hans-Christian Pape
Affiliation:
University of Pittsburgh
Reinhard Meier
Affiliation:
Hannover Medical School
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Summary

OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF CONDYLAR FRACTURES

Indications

  • Unstable dislocated intra-articular condylar fractures (Fig. 6.12).

Pre-operative planning

Clinical assessment

  • Local pain and swelling.

  • Assess and document neurovascular status of finger.

  • Assess and document axial or rotational dislocation.

Radiological assessment

  • Standard anteroposteriorandlateral radiographsofthe finger.

Operative treatment

Anaesthesia

  • Brachial plexus block, intravenous regional anaesthesia or general anaesthesia.

  • At induction, administer prophylactic antibiotic as per local hospital protocol (e.g. 3rd generation cephalosporin).

Table and equipment

  • Hand surgery instrumentation set.

  • Hand small-fragment implant system.

  • K-wires 1.0-1.2 mm.

  • A radiolucent armtable.

  • An upper armtourniquet.

  • An image intensifier.

Table set up

  • The instrumentation is set up on the side of the operation.

  • Image intensifier is fromthe front side of the armtable. Check for adequate visualization in 2 planes prior to draping.

Patient positioning

  • Supine, pronated armon armtable.

Draping, surgical approach and implant Positioning

  • Place tourniquet at upper arm.

  • Prepare the skin over elbow, forearm, wrist and hand with usual antiseptic solutions (aqueous/alcoholic povidone-iodine).

  • Apply adherent drape circularly above the elbow, so free motion of the elbow is possible.

  • Tourniquet after exsanguination.

  • Skin incision via a dorsal ‘S’ or ‘Z’ approach to the metacarpophalangeal or interphalangeal joint. In combined fractures the skin incision is via the wound.

  • Incision of the extensor tendons.

  • Open joint.

  • Reduce fracture under direct vision.

  • […]

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Publisher: Cambridge University Press
Print publication year: 2006

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