K-wire fixation

Percutaneous K-wire fixation is often used for transverse fractures of the middle phalangeal diaphysis.

The advantages are:

• Minimal soft-tissue insult
• Low cost
• Universal availability

However, there are some disadvantages which can sometimes be significant, such as:

• Less stable fixation
• No interfragmentary compression
• May separate the fragments
• Delayed mobilization
• May irritate the overlying skin

f the fracture is visible on AP view a lateral approach is used.

If the fracture is visible on lateral view a dorsal approach is used.

The wire should be inserted in the coronal plane, in order to avoid impaling any tendons.

Be sure that the point of entry in the side of the finger is dorsal to the neurovascular bundle.

Use a fine drill guide through a small stab incision.

Insert the wire into the near fragment, then confirm reduction before advancing into the far fragment.

Make sure that the tip of the wire engages the opposite cortex but does not project beyond it.

Protect the digit with buddy strapping to the adjacent finger, to neutralize lateral forces on the finger.

While the patient is in bed, use pillows to keep the hand elevated above the level of the heart to reduce swelling.

See the patient 5 days and 10 days after surgery.

The patient can begin active motion (flexion and extension) immediately after surgery.

For ambulant patients, put the arm in a sling and elevate to heart level.

Instruct the patient to lift the hand regularly overhead, in order to mobilize the shoulder and elbow joints.

The implants may need to be removed in cases of soft-tissue irritation.

In case of joint stiffness, or tendon adhesion’s restricting finger movement, tenolysis, or arthrolysis become necessary. In these circumstances, take the opportunity to remove the implants.