Open reduction of proximal phalanx fractures

The first metacarpal base fracture (bennett fracture) is an unstable fracture. Anatomically, the first metacarpal and the multi-corner bone form a saddle joint, which is flexible and stable. When the violence acts on the saddle-shaped nodule along the longitudinal axis of the thumb, an oblique fracture from the top to the bottom of the first metacarpal can be formed. . Due to the attachment of the ligament and joint capsule, the proximal fracture block can maintain the anatomical relationship with the large angle bone. The distal fracture segment is displaced to the temporal and dorsal side due to the traction of the abductor thumb. Bennett's fracture reduction is easier, and it is more difficult to maintain the contraposition. It is easy to be displaced after the reduction and deformed. Therefore, this fracture often requires open reduction. Treatment of diseases: phalangeal fractures Indication 1. Open surgical injury combined with palm and phalanx fractures, often in the internal fixation of debridement and repair. 2. Closed palm and phalanx fractures are performed only after reduction failure, or difficulty in resetting (such as excessive fracture time) or unstable fracture. Contraindications 1.4 The metacarpal bones are juxtaposed, and there is no rotation activity between the muscles. Therefore, a single needle can be used for fixation, and the four fingers are separated, and the single root is fixed through, which is difficult to control the rotation activity, and should be fixed by double needles. 2. Unstable metacarpal fractures are fixed with a single needle. If the fracture end is unstable, a Kirschner wire can be inserted transversely from the distal segment of the fracture and laterally fixed with the adjacent metacarpal. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture sites should be taken with positive lateral radiographs to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take X-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure Right small finger proximal section fracture, knuckle shortening and angular deformity. The orthodontic and oblique X-ray films of the injured finger showed fracture and dislocation. The small finger is near the ulnar longitudinal incision, revealing the fracture end. The fracture end tissue was cleaned and the fracture was restored under direct vision. Use Kirschner wire for cross fixation. X-ray films showed fracture fixation. The wound was closed and the external fixation was performed with a plaster cast until the initial healing of the fracture. You can start practicing before you remove the Kirschner wire. The ring refers to the large oblique fracture of the proximal phalanx. It is easy to shorten the deformed healing by external fixation. Open reduction and internal fixation can be used. If the equipment is good, there are X-ray fluoroscopy machines, micro-electric or pneumatic drills, etc. It is also feasible to close the reduction and percutaneous Kirschner wire internal fixation. Be careful not to hurt the nerves, blood vessels, flexor and extensor tendons. The ring refers to the proximal midline incision. Revealed the fracture. Do not separate the extensor tendon. The fracture was restored under direct vision. The fracture was fixed across two Kirschner wires. Close the wound. X-ray films confirmed good fracture reduction and internal fixation. Fix the brake finger for 4 weeks, start protective joint activity until bone healing, and remove the Kirschner wire. complication Can be complicated by median nerve injury and flexor tendon rupture.