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Phalangeal Frx Intraosseous Wires

- See: Phalangeal Frx

- Indications:
    - open transverse phalangeal fractures, replantation;
    - certain transverse phalangeal fractures, avulsion & intra-articular fractures;

- Advantages:
    - allows fixation of small intra-articular frx fragments;
    - there is no transfixation of soft tissues, which is seen w/ multiple K wire fixation;

- Technique:
    - involves passage of stainless steel loop of wire (26 gauge) across fracture line dorsal to the midaxis and insertion of oblique K wire to neutralize rotational forces;
    - prior to fracture reduction, a 0.042 inch K wire is driven obliquely across frx;
    - make 2 drill holes w/ K wire parallel to & 5 mm from the frx ends, dorsal to mid axis of bone;
    - 26 gauge (No 0) stailless steel wire is passed thru the holes & twisted;

- Type A Intra-osseous Wiring:
    - utilizes 26 guage stainless steel wire and 0.035 inch wires;
    - indicated for arthrodesis or transverse phalnageal frxs;
    - the interosseous portion of the wire runs parallel to the frx line;
    - the wire provides for rotatory and lateral angulatory control;
    - wire insertion technique:
              - a 0.035 K wire is used to drill two holes parallel to the frx (or joint line);
              - holes are located 5 mm to the frx site, slightly dorsal to the midline;
              - wire is inserted and loop is made on non-contact side of digits;
                     - do not tighten down the loop until the K wire is iserted;
    - K wire fixation:
              - in the proximal phalanx a dorsal midline incision is utilized;
              - because the intra-osseous wire does not provide AP stability, a single 0.035 inch K wire is passed across the frx site, either obliquely (securing two cortices) or longitudinally down the frx site;
    - wire tightening:
              - wire is tighten down in usual manner;
              - end of wire loop is placed into a cortical hole made by the K wire;

- Type B Wiring:
    - indicated for intra-articular fractures;
    - cortical holes are made at right angles to the fracture site so that the wires cross the frx line, wrap around the frx fragment, and allow direct compression;
    - first reduce the fracture w/ reduction clamp;
    - subsequently drill parallel holes at right angles across the frx sites, and then the No. 0 wire is passed thru the path made by the K wire;
             - consider use of a 20 gauge needle into the drill hole to facilitate passage of the monofilament wire

Intraosseous Wiring of the Digital Skeleton.

Tension wire fixation of avulsion fractures in the hand.

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