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Limited Open Reduction and Internal Fixation of Proximal Phalanx Fractures With Two Headless Screws

March 01, 2020

Contributors: Robert Raphael Leggon Gray, MD, FAAOS; Jason West

Closed reduction of proximal phalanx fractures is performed under fluoroscopic guidance and with the use of local anesthesia. Two small stab incisions are made through the skin only on both sides of the metacarpal head at the level of the collateral recess. Guidewires are inserted to the base of the proximal phalanx at the 2:30 and 9:30 clock-face positions and drilled antegrade in a converging but not crossing fashion. Orthogonal fluoroscopic imaging is used to confirm adequate fracture reduction and wire placement. Using a hand driver rather than a power driver, the wires are overdrilled, countersunk, and measured. Screws of an appropriate length are placed. Although ideal, it is not necessary for the screws to be equal in length if adequate purchase is attained proximal and distal to the fracture line. The patient is immobilized for 3 days postoperatively, after which early, active occupational therapy initiated.

Results for "Hand & Wrist"

2 of 8
2 of 8

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