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K-wires for phalanx fracture fixation may lead to later finger stiffness
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LIVERPOOL, United Kingdom — Reduction and K-wire fixation are two effective treatment options for epi basilar fractures — the kind of fractures at the base of the phalanx that are often seen in conjunction with distal radius fractures. However, how well each treatment works depends on the stability of the fracture, according to a presenter at the British Orthopaedic Association Annual Meeting.
“I try and reduce it. If they are stable enough, I ask them to move straight away. If that is not stable, then I go on to K-wire fixation,” Vijay Bhalaik, MBBS, MRCS, FRCS (T&O), said, here.
He discussed the pitfalls of various phalangeal fractures, which are the second most common fracture in the body, and said fluoroscans and image intensifiers are two good methods for visualizing the extent of a phalanx fracture.
In an epi basilar fracture, the base of the phalanx sits where it should sit and the extensor mechanism pulls the distal phalanx, according to Bhalaik.
He described a technique he learned for fixing these fractures that involves placing an intra-articular wire through the metacarpal head.
“It is quite useful. I do not use it that often now, but it is a useful technique and obviously in the more serious cases you may have to fix it. Fixation looks good on X-rays, but it can be associated with stiffness,” he said.
During his presentation, Bhalaik, who practices at Spire Murrayfield Hospital Wirral, said simple treatments for phalanx fractures are important and often the best.
“Over the years, I am treating more and more complex fractures with less and less intervention,” he said. – by Susan M. Rapp
Reference:
Bhalaik V. BSSH Revalidation: Fractures and dislocations of the hand — Phalangeal fractures. Presented at: British Orthopaedic Association Annual Congress; Sept. 15-18, 2015; Liverpool, United Kingdom.
Disclosure: Orthopaedics Today Europe was unable to determine whether Bhalaik has relevant financial disclosures.