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ORIF of Hand Frx w/ K Wires

- Discussion:
    - K wires should never cross at the fracture site, since this will cause rigid distraction;
    - K wires should cross either proximal or distal to the fracture and gain firm anchorage in the proximal and distal metaphysis;

- Holding Power of the Wires:
    - increased penetrating ability and holding power with trocar tips, when compared to diamond tips;
    - increased holding power w/ lower drilling speeds;

- Indincations:
    - unstable phalangeal fractures;
    - Metacarpal Fractures involving isolated shaft, neck, or base frx;

- Technique for Proximal Phalanx Fractures:
    - apply longitudinal traction & flex MP joint to 80 deg & PIP to 45 deg;
    - for transverse frxs, place K wire (0.045 inch) on metacarpal head (to one side of extensor tendon) & drive wire down shaft until wire reaches subchondral bone in head of the phalanx;

- Phalangeal Neck Fractures:
    - may be unstable & may need 2 or 3 0.028 inch K wires;

- Oblique Fractures:
    - reduction of spiral and oblique fractures is maintained w/ pointed reduction clamp;
    - 2 or 3 0.28 inch K wires are inserted across fracture perpendicular to long axis of phalanx & engage both cortices of the phalanx;
    - wires should be placed as far as possible from each other along length of the fracture line

Extension block pinning for proximal interphalangeal joint fracture dislocations: preliminary report of a new technique.

Complications of smooth pin fixation of fractures and dislocations in the hand and wrist.

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