![]() juncturae tendinum interconnecting the common extensor tendons can be split to enhance exposure (tag for later repair) border metacarpals are approached thru longitudinal incisions between 2nd and thrid or fourth and fifth metacarpals longitudinal incision made either between on the outer border of the metacarpals Ĭomplications of plate fixation in the hand skeleton. Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries. Rigid fixation of phalangeal and metacarpal fractures. ![]() Rigid internal fixation in the hand: 104 cases. Unstable metacarpal and phalangeal fracture treatment with screws and plates. prebending of the plate slightly beyond the normal metacarpal bow allows restoration of the anterior cortical butress w/ segmental defects or comminution a 2.7 mm DCP is required quater tubular plate or 2.7 mm DCP as neutralization plate, especially in lag screw fixation of second to fifth metacarpals, esp w/ spiral fractures with rotational displacement plates must be placed on the dorsal surface inorder to function as a tension band w/ comminution, use stronger implant such as 2.7 mm DCP & consider bone grafting this will allow plate to function as a tension band plate in absence of comminution & intact palmar cortex, one quarter tubular plate w/ 2.7 mm screws is adequate overlying soft tissues must be intact for plate fixation indicated for multiple metacarpal shaft frx, or other unstable shaft fractures that cannot be help reduced w/ K wires or screws drilling a hole more than 30% of the shaft diameter, leads to a 90% reduction in torsional rigidity note: the drilling into small bones does have an effect of torsional rigidity generally two screws are required for metacarpal shaft fractures screws should be countersunk to remove prominent head and to improve loading characteristics 2.0 mm screws are applied to the cortex and the 2.7 mm screws are applied to the metaphysis 2.0 mm or 2.7 mm cortex screws as lag screws in spiral frx Ībsorbable intramedullary implants for hand fractures. percutaneous pinning w/ 1.6 mm or 2.00 m K wires in small fragments Ĭomplications of smooth pin fixation of fractures and dislocations in the hand and wrist.
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