Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al. |
The Kirschner unthreaded sharp-point wire remains a common method for fracture fixation in the hand, owing to the ubiquitous nature of the equipment, the inexpensive cost of the implant, and the resulting adequate and rapid immobilization provided to the fracture. In most cases, the ease of application has added to its popularity, although K-wire fixation in complex fractures may be both difficult and time-consuming. Disadvantages are a possible distraction of the fracture during multiple wire placement and the impingement on surrounding soft tissue when placed percutaneously. Moderate to poor stabilization with later loosening can occur, requiring protective splinting. The external pin sites in percutaneous wires provide a site for infection that may progress into soft tissue and bone. Buried subcutaneous pins, particularly if destined to remain in place for an extended period, may be desirable but require incision for removal.
FIG. 32-01. A. Extensor tendon, B. Flexor tendon, C. Lumbrical.
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WIRE FIXATION Many different wire loop techniques are listed in the literature, 3,5,15,17 and can be grouped into two main types, those with and those without tension band function. Nontension band wires are usually 26- or 28-gauge steel wire placed through drilled holes in the proximal and distal fracture fragments with minimal periosteal dissection. Comminuted fractures may have to be wired fragment to fragment with fine wire before the major parts are fixed. Advantages include commonly available equipment, quick placement, reasonable strength, and minimal implant bulk. Disadvantages include the prolonged presence of a buried foreign body, slightly increased soft tissue dissection compared with K-wires, and wire fatigue and breakage that may result in loss of fracture reduction. Cerclage or encircling wire loops are useful with oblique, tubular, or diaphyseal fractures, containing multiple fracture fragments and reducing the area of required callus. They may be combined with other implants and are not compressive. Care should be taken to groove or drill the cortex to anchor the loop in place and to place the twist or knot closure away from gliding tissue. |
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