Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section III - Fractures of the phalanx
from Chapter 6
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF CONDYLAR FRACTURES
Indications
Unstable dislocated intra-articular condylar fractures (Fig. 6.12).
Pre-operative planning
Clinical assessment
Local pain and swelling.
Assess and document neurovascular status of finger.
Assess and document axial or rotational dislocation.
Radiological assessment
Standard anteroposteriorandlateral radiographsofthe finger.
Operative treatment
Anaesthesia
Brachial plexus block, intravenous regional anaesthesia or general anaesthesia.
At induction, administer prophylactic antibiotic as per local hospital protocol (e.g. 3rd generation cephalosporin).
Table and equipment
Hand surgery instrumentation set.
Hand small-fragment implant system.
K-wires 1.0-1.2 mm.
A radiolucent armtable.
An upper armtourniquet.
An image intensifier.
Table set up
The instrumentation is set up on the side of the operation.
Image intensifier is fromthe front side of the armtable. Check for adequate visualization in 2 planes prior to draping.
Patient positioning
Supine, pronated armon armtable.
Draping, surgical approach and implant Positioning
Place tourniquet at upper arm.
Prepare the skin over elbow, forearm, wrist and hand with usual antiseptic solutions (aqueous/alcoholic povidone-iodine).
Apply adherent drape circularly above the elbow, so free motion of the elbow is possible.
Tourniquet after exsanguination.
Skin incision via a dorsal ‘S’ or ‘Z’ approach to the metacarpophalangeal or interphalangeal joint. In combined fractures the skin incision is via the wound.
Incision of the extensor tendons.
Open joint.
Reduce fracture under direct vision.
[…]
- Type
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 109 - 114Publisher: Cambridge University PressPrint publication year: 2006