synonyms:phalanx fracture ORIF, phalangeal fracture ORIF, finger ORIF, phalanx fixation
CRPP/ ORIF Hand Fracture CPT
CRPP/ ORIF Hand Fracture Indications
- Displaced metacarpal and phalangeal fracture
CRPP/ ORIF Hand Fracture Contraindications
- Medically unstable patients
- Active infection
CRPP/ ORIF Hand Fracture Alternatives
CRPP/ ORIF Hand Fracture Pre-op Planning
- No difference between Kirschner wire and lag screw fixation (Horton TC, J Hnd Surg BR 2003;28:5).
- Bicoritcal screw fixation has demonstrated good outcomes (Roth JJ, J Hand Surg 2005;30A:151).
CRPP/ ORIF Hand Fracture Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- General endotracheal anesthesia
- position. All bony prominences well padded.
- Examination under anesthesia.
- Prep and drape in standard sterile fashion.
- Close in layers.
Phalangeal Shaft Fracture CRPP Technique
- Belsky MR, J Hand Surg 1984;9Am:725
- 0.045 (1.1mm) K-wires generally used. Consider 0.062in(1.6mm) for larger bones(metacarpal); 0.035in(0.9mm) for smaller bones (pediatric fx).
- Closed reduction under c-arm guidance.
- one or more intramedullary or two crossed K-wires.
- K-wires must not cross at the fracture site.
- K-wires are left in until fracture callus in visible on xray. Usually 3-4 weeks
CRPP/ ORIF Hand Fracture Complications
- Loss of reduction
- Delayed union
- Tendon adhesion / stiffness
- Nerve or vascular injury
- Painful hardware
CRPP/ ORIF Hand Fracture Follow-up care
- Post-op /Initial: Splint. Elevation.
- 7-10 Days: xray to ensure reduction is maintained. Continued splint, activity modifications. Immobilize as few joints as necessary. Begin ROM as soon as fixation strength with allow.
- 6 Weeks: Remove k-wire, wean from splint use as soon as callus is visible on xray. Continue activity modifications. Agressive ROM.
- 3 Months: Resume full activities. Assess ROM. Consider flexor/extensor tenolysis if tendon adhesions fail to improve.
- 1Yr: assess outcomes / follow-up xrays.
CRPP/ ORIF Hand Fracture Outcomes
CRPP/ ORIF Hand Fracture Review References
- Rockwood and Greens
- Greens Hand Surgery