Clinical orthopaedics and related research
-
Tension band wiring is a simple, predictable method of internal fixation for avulsion fracture in the hand. These fractures include the bony gamekeeper, bony mallet, and fractures associated with proximal interphalangeal joint trauma. By the placement of a small gauge wire through the insertion of the ligament or tendon onto the fracture fragment, the tension wire technique avoids many of the pitfalls of internal fixation and also takes advantage of its physiologic and biomechanical position.
-
Stable fractures of the metacarpal and proximal phalanges can be treated satisfactorily by closed methods. The problem in those unstable fractures is whether to treat with open or closed reduction. Stiffness of the proximal interphalangeal joint (PIP), malunion, rotation deformities, shortening, and nonunion are known complications of fractures of the proximal phalanx. ⋯ Fractures at the base of the proximal phalanx have low incidence of complications if they are treated closed. Fractures at the shaft carry a much larger risk of complications with either type of treatment. This study of 158 fractures of the proximal phalanx demonstrates that there is a place for conservative treatment in the management of unstable shaft fractures of the proximal phalanx.