To define safe corridors for K wiring in phalanx fractures to achieve good functional outcome
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:89
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Mohammed J R, Chandrabose R
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Unstable phalangeal fractures are commonly treated with K wire fixation. The technique of K wiring in different types of phalangeal fractures was not standardised.
The aim of our study was to define the safe corridor for K wire fixation in phalanx fractures of different geometry, to achieve maximum range of movements without much impalement of soft tissues like extensor expansion, long and short finger flexors and extensors, collateral ligaments and neurovascular bundle.
A stable bony construct has to be restored for early mobilisation. Early mobilisation can prevent adhesions and is a key for good clinical outcome. Initial cadaveric study was done to map the safe portals for K wire entry in proximal, middle and distal phalanx and the same was implemented clinically in 50 patients with 64 phalanx fractures treated from 2011 to 2012 with inclusion and exclusion criteria. 38 proximal phalanx fractures, 14 distal phalanx fracture and 12 middle phalanx fractures were treated. Little finger was most commonly involved. 30 patients had transverse fracture which was the commonest pattern followed by spiral, oblique, comminuted and avulsion fracture in descending order. All patients had either finger or wrist block, performed by single surgeon and ‘on table active finger movement test’ was done in all patients to assess the tethering of soft tissues.
The results were analysed using radiology, Belsky’s criteria grading and Disability of Arm, Shoulder and Hand (DASH) score. All were followed up for a period of 12 to 18 months. 48 patients achieved excellent score and 2 with good score (one had pin tract infection and other patient did not attend physiotherapy resulting in terminal stiffness).
Our best results proves the importance of the safe corridor usage in performing K wire, which are mapped for each phalanx in flexion and extension position. We also conclude that there is a direct correlation between demonstration of active full range of motion (on table test) after performing K wire through safe portals, and to the final outcome as shown in our results. This is a very valid test need to be performed to know the placement of K wire in the safe corridor
|How to Cite this Abstract|
|Mohammed J R, Chandrabose R. To define safe corridors for K wiring in phalanx fractures to achieve good functional outcome. International Journal of Conference Proceedings 2015;(2015):89|