Clinical Example: Percutaneous fixation of proximal fracture of the proximal phalanx

Fractures of the proximal part of the proximal phalanx are often unstable and angulate dorsally. Longitudinal percutaneous fixation may not provide adequate purchase on the proximal fracture fragment. These intraoperative flouroscopy images show a method of increasing stability of percutaneous fixation in a malaligned three week old fracture by placing additional pins into the proximal fracture fragment.

 
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The initial malalignment. Notice the typical zig zag collapse pattern resulting in flexion of the proximal interphalangeal joint to the same degree as the fracture angulation.
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Manipulation and closed reduction:
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Percutaneous pins placed across the fracture line and also dorsal to palmar into the proximal fracture fragment.
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The pins were left protruding through the skin, and were bent toward each other to form a common zone of overlap which was glued together with aquaplast to form an external fixation construct.
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