gms | German Medical Science

Objectives/Interrogation: Proximal interphalangeal joint (PIPJ) pilon fractures of the hand are common and difficult to treat. This is often from an axial loading pattern of injury, resulting in splaying of the PIPJ with compression of the central portion of the articular surface. In select patients, operative management is undertaken in the form of dynamic frames such as a Suzuki frame or open reduction internal fixation (ORIF) with plates, with or without bone grafting.

Methods: Invariably, traction is required intra-operatively to assess reduction. It is often difficult to maintain accurate reduction with the lead surgeon or assistant pulling on the end of the digit, and often leads to the clinicians fingers being inadvertently exposed to radiation. In our practice, we have found an effective method to apply traction and avoid radiation exposure to our surgeons hands. We pass a 15cm transverse kirshner wire (k-wire), usually a 1.1 or 1.3 through the head of the middle phalanx, and leave the ends long. A surgical swab is wrapped around on each end of the k-wire and traction can be applied. Should reduction be acceptable with traction, this wire can then be the distal wire of an external fixation such as a Hynes Giddens or Suzuki frame. When the fracture extends distally to involve the distal aspect of the middle phalanx, this transverse wire is passed transversely through the base of the distal phalanx. This can be removed at the end of the ORIF. In addition to traction, the wire ends aid in retraction the other fingers dorsally during ORIF.

Results and Conclusions: We have found this maneuver extremely useful in managing what is often a tricky fracture. We would like to share this tip with photos and imaging.