Authors of section

Authors

Richard Buckley, Andrew Sands, Michael Castro, Christina Kabbash

Executive Editors

Joseph Schatzker, Richard Buckley

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ORIF or K-wire fixation

1. Nonoperative treatment

Nonoperative treatment involves manual reduction, buddy taping or a hard-sole shoe, until the fracture site is non-tender.

orif or mtp joint fusion

2. Patient preparation

This procedure is normally performed with the patient in a supine position.

nonoperative treatment

3. Closed reduction and K-wire fixation

When operative treatment is indicated, closed reduction and K-wire fixation is appropriate in most cases.

After manual reduction, one K-wire is placed to secure the fracture fragment perpendicular to the line of the fracture. A second K-wire is placed in the sagittal plane to maintain alignment of the hallux at the IP joint.

orif or k wire fixation

This image shows the fracture treated with closed reduction and percutaneous K-wire fixation.

orif or k wire fixation

4. Open reduction internal fixation

Approach

Intraarticular head fractures of the proximal phalanx of the hallux may be approached through a medial approach to the hallux.

medial approach to the hallux

Irrigation

Irrigate the fracture. The displaced fracture fragment(s) is mobilized using a dental pick or Freer elevator.

orif or k wire fixation

Reduction

The split wedge fragment is reduced with a small bone tamp or elevator, and held in position with pointed reduction forceps.

orif or k wire fixation

Lag screw fixation

A 2.0 mm or 2.4 mm lag screw is placed through the fragment perpendicular to the fracture site by drilling the appropriate gliding and thread holes.

Use fully threaded screws for lag screws.

orif or k wire fixation

5. Aftercare

Weight bearing may be allowed as long as the patient is provided with a flat, rigid sole shoe which is continued for 6-10 weeks, until X-rays or clinical examination is consistent with healing.

If K-wires are present, these are to be removed in the clinic at six weeks.

nonoperative treatment