Chapter 41 Finger Fractures



10.1055/b-0037-142212

Chapter 41 Finger Fractures

Donald H. Lalonde

ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET FOR FINGER FRACTURE REDUCTION

Clip 41-1 Early protected movement 3 days after K-wiring middle phalanx fracture.



  • When you see full flexion and extension of the finger you have K-wired at surgery and see that your reduction is stable with fluoroscopy, you will feel a lot more comfortable about starting early protected movement for these fingers, just as in flexor tendon injuries.1,2



  • After you reduce the fractures, you can watch the patient, who is comforable and tourniquet free, move the reconstructed bone to see how stable the fixation is. You can add more K-wires if you feel greater stability is needed to support early protected movement.



  • You can see whether the K-wires are interrupting active finger movement by impinging on ligaments or tendons in their current location. You have the opportunity to change the K-wire location to optimize postoperative early active movement before the end of the operation.

Clip 41-2 Two finger fractures: numbing, intraoperative testing of functionally stable fixation of K-wire reduction, early protected movement demonstration, and final result.



  • A major advantage of eliminating sedation for finger fractures is that you do not need to perform the reduction in the main operating room (see Chapters 10 and 16). If patients need internal fixation, you can perform closed reduction and K-wire insertion in minor procedure rooms in the clinic outside the main operating room Monday to Friday, 9 AM to 5 PM (see Clip 41-3). You no longer need to do these at night to suit the main operating room and anesthesiologist′s schedules. You are more likely to do better surgery with a clear head at 1 PM than when you are tired at 1 AM. You no longer have to admit patients to the hospital because of their medical comorbidities; these issues are only a problem when you use sedation.



  • Because you can perform these operations in the clinic, your hand therapists can see how much active finger movement is possible during the surgery. You can discuss the safe early protected movement plan with therapists during and after the surgery (see Chapter 15).



  • All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.

Clip 41-3 Augmented field sterility setup for inserting K-wires in a minor procedure room.


WHERE TO INJECT THE LOCAL ANESTHETIC FOR FINGER FRACTURE REDUCTION

Palmar injections: Inject 4 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate) in the most proximal red injection point on the palmar side. Do the most proximal dorsal injection next, and then inject 2 ml in the middle of each of the palmar proximal and middle phalanges in the subcutaneous fat. Dorsal injections: Inject 4 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate) bicarbonate in the proximal red injection dot on the dorsal hand. Do the two palmar injections next, and then inject 2 ml in the middle of each of the dorsal proximal and middle phalanges in the subcutaneous fat.



  • See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.

Clip 41-4 Real-time minimal pain local injection for proximal phalanx fracture.

Only gold members can continue reading. Log In or Register to continue

May 29, 2020 | Posted by in ORTHOPEDIC | Comments Off on Chapter 41 Finger Fractures
Premium Wordpress Themes by UFO Themes