A simple and low-cost external fixator for infected hand injuries

One-stage Distal Interphalangeal Joint Fusion With External Fixator for the Treatment of Septic Joint Arthritis

Septic joint arthritis in the small joints of the hand can be caused by penetrating trauma, ruptured ganglion cysts, or open joint dislocations, among others. The use of external fixation for the treatment of this condition has been reported in the past as a means of temporary joint distraction, or for secondary fusion procedures. In the present article, the authors describe a surgical technique involving the use of a low-cost external fixator for the primary arthrodesis of infected distal interphalangeal joints of the hand. The external fixator is fabricated with simple materials, threaded Kirshner wires, bone cement, and an insulin syringe, which the authors have used to fuse the distal interphalangeal joint primarily when destroyed by septic arthritis.

Interlocking K Wires Followed by Immediate Mobilization for Fractures of the Hand

We describe a technique of interlocking Kirschner wires to improve stability after fixation of fractures of the hand. This enables immediate mobilization of the injured fingers thus reducing the need for prolonged postoperative physical therapy and consequently diminishing chances of posttraumatic stiffness. This study analyzes outcomes in 83 fractures in 70 patients including 26 metacarpal and 57 phalangeal fractures. The technique has proven to be simple, versatile, and cost-effective. Patient compliance and satisfaction has been high and results have been gratifying.

Skeletal Fixation in a Mutilated Hand

Hand fracture fixation in mutilating injuries is characterized by multiple challenges due to possible skeletal disorganization and concomitant severe injury of soft tissue structures. The effects of skeletal disruption are best analyzed as divided into specific locales in the hand: radial, ulnar, proximal, and distal. Functional consequences of injuries in each of these regions are discussed. Although a variety of implants are now in vogue, K-wire fixation has stood the test of time and is especially useful in multiple fracture situations. Segmental bone loss is quite common in such injuries, which can be safely reconstructed in a staged manner.

A Simple Phalangeal External Fixator Using Kirschner Wires and Locking Balls: No Need for Cement or Rubber Bands

The currently available phalangeal external fixators are either commercial and not universally available or made of Kirschner wires and a linkage mechanism such as rubber bands and cement. They are difficult to assemble and difficult to adjust after application. This paper presents an external fixator made of Kirschner wires and locking balls (better known by their commercial name: Jurgan Balls) that is easily assembled on demand in the operating room. The fixator can be applied statically as well as dynamically allowing motion across the interphalangeal joint. I have applied this fixator in a variety of fracture patterns in a total of 14 patients: 11 phalangeal fractures and 3 metacarpal fractures. The fixator was solid and maintained reduction in all phalangeal fractures. Two thumb metacarpal fractures were adequately fixed. One fourth metacarpal fracture failed fixation during surgery and required a different method of fixation. There was no loss or reduction of any of the fractures in the postoperative period. There were no nonunions and no need for second-stage surgeries. All fixators were removed in the clinic without anesthesia. The described external fixator is made of components that are readily available in most operating rooms. It does not require the use of cement or rubber bands. It allows adjustment during surgery and maintains the reduction throughout the postoperative period. It may be a useful tool for open and/or highly comminuted fractures and fracture subluxations of the proximal and middle phalanges as well as the thumb metacarpal.