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Spiral Oblique Proximal Phalanx Frx

- Disscusion
    - these frx are inherently unstable, and requires internal fixation;

- Percutaneous Fixation Technique:
    - reduction is achieved w/ a tenaculum fracture 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 are cut 2-3 mm from the skin edge (leave the wires protruding on the outside of the border digits);
    - wires should be placed as far as possible from each other along length of the fracture line;
    - after passing each wire, ask the patient to flex and extend the fingers to ensure that there is no transfixation of the lateral bands;
    - well padded dressing is then applied to protect the pin sites, but it is important that there remains some PIP motion;
    - post op:
           - generally the cast is left on for upto 4 weeks (one week longer than is necessary for transverse fractures)

 Closed Reduction and Internal Fixation of Proximal Phalangeal Fractures.