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Safe corridors for K-wiring in phalangeal fractures

BACKGROUND: Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation a...

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Autores principales: Rex, C, Vignesh, R, Javed, M, Balaji, Subba Chandra, Premanand, C, Zakki, Syed Ashfaque
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510790/
https://www.ncbi.nlm.nih.gov/pubmed/26229157
http://dx.doi.org/10.4103/0019-5413.159591
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author Rex, C
Vignesh, R
Javed, M
Balaji, Subba Chandra
Premanand, C
Zakki, Syed Ashfaque
author_facet Rex, C
Vignesh, R
Javed, M
Balaji, Subba Chandra
Premanand, C
Zakki, Syed Ashfaque
author_sort Rex, C
collection PubMed
description BACKGROUND: Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. MATERIALS AND METHODS: In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). RESULTS: 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. CONCLUSION: K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing “on-table active finger movement test” at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.
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spelling pubmed-45107902015-07-30 Safe corridors for K-wiring in phalangeal fractures Rex, C Vignesh, R Javed, M Balaji, Subba Chandra Premanand, C Zakki, Syed Ashfaque Indian J Orthop Original Article BACKGROUND: Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. MATERIALS AND METHODS: In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). RESULTS: 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. CONCLUSION: K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing “on-table active finger movement test” at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4510790/ /pubmed/26229157 http://dx.doi.org/10.4103/0019-5413.159591 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Rex, C
Vignesh, R
Javed, M
Balaji, Subba Chandra
Premanand, C
Zakki, Syed Ashfaque
Safe corridors for K-wiring in phalangeal fractures
title Safe corridors for K-wiring in phalangeal fractures
title_full Safe corridors for K-wiring in phalangeal fractures
title_fullStr Safe corridors for K-wiring in phalangeal fractures
title_full_unstemmed Safe corridors for K-wiring in phalangeal fractures
title_short Safe corridors for K-wiring in phalangeal fractures
title_sort safe corridors for k-wiring in phalangeal fractures
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510790/
https://www.ncbi.nlm.nih.gov/pubmed/26229157
http://dx.doi.org/10.4103/0019-5413.159591
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