Failed phalangeal and metacarpal fracture management

FailedPhalangealandMetacarpalFractureManagement

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กลุ่มงานออร์โธปิดิกส์ โรงพยาบาลมหาราชนครราชสีมา

Annual Hand Meeting 2017 “Simply, Beyond Textbook!”

Failed (adj.)= unsuccessful

Verb:

Definitionof“Fail”

Verb:

• to be unsuccessful when you are trying to do something

Definitionof“Fail”

Verb:

• to be unsuccessful when you are trying to do something

• to not do something that people expect you to do

Definitionof“Fail”

Verb:

• to be unsuccessful when you are trying to do something

• to not do something that people expect you to do

• to be unsuccessful in achieving a satisfactory level or standard

Definitionof“Fail”

ComplicationsofPhalangealFracture

• Malunion

• Malrotation

• Apex volar angulation

• Lateral angulation

• Shortening

• Articular malunion

• Nonunion

• Loss of Motion

• PIP joint extension lag

• Flexor tendon entrapment

• Infection

PhalangealMalunion

•Angular malunion•Malrotation

Malrotation

ClosedWedgeVSOpenWedgeO

steo

tom

y

ClosedWedgeVSOpenWedgeO

steo

tom

yNo bone

graft

ClosedWedgeVSOpenWedgeO

steo

tom

yNo bone

graft

Shortened

ClosedWedgeVSOpenWedgeO

steo

tom

yNo bone

graft Bone graft

needed

Shortened

ClosedWedgeVSOpenWedgeO

steo

tom

yNo bone

graft Bone graft

needed

Shortened Maintained length

FocalO

steo

tom

y Extrafocal

FocalO

steo

tom

yCorrect at the

site

Extrafocal

FocalO

steo

tom

yCorrect at the

site

Extrafocal

Multi-planar correction

FocalO

steo

tom

yCorrect at the

site

Extrafocal

Multi-planar correctionPlanned soft

tissue correction

FocalO

steo

tom

yCorrect at the

siteSuitable for

small area to correct

Extrafocal

Multi-planar correctionPlanned soft

tissue correction

FocalO

steo

tom

yCorrect at the

siteSuitable for

small area to correctNo soft tissue

correction needed

Extrafocal

Multi-planar correctionPlanned soft

tissue correction

CasePresentation

Case#1

10 years old boy

Old finger injury 8 years ago

PatientEvaluation

• Lateral angular deformity of P2

• Scar contracture

• Immature bone

• Spared DIP joint motion

PreoperativePlanning

• Correct angular deformity: Closed wedge osteotomy at P2

• Skin resurfacing: Homodigital neurovascular island flap

• Minimal growth disturbance

Bone Work

Soft Tissue Work

Immediate postoperative Film

2 weeks later…

Index finger and the lost K-wire!

9 months later

9 months later

Arthrodesis of DIP joint, but preserve epiphyseal plate

2 months after 2nd operation

2 months after 2nd operation

2 months after 2nd operation

2 months after 2nd operation

Case#2

Simple fracture?

OMG!

Malrotation

Case#3

Courtesy of Dr. Manita Tiratrakoonwichaya

Courtesy of Dr. Manita Tiratrakoonwichaya

Courtesy of Dr. Manita Tiratrakoonwichaya

* *

Courtesy of Dr. Manita Tiratrakoonwichaya

* *

Courtesy of Dr. Manita Tiratrakoonwichaya

ก่อนออกจากห้องผ่าตัด....Tip

ก่อนออกจากห้องผ่าตัด....Tip

ก่อนออกจากห้องผ่าตัด....

Tenodesis effect

Tip

TakeHomeMessage

• Prevention is better than correction

• รู้เขา รู้เรา

• Surgical management vs nonsurgical management