Phalanx Fracture ORIF 26735

synonyms:

CRPP/ ORIF Hand Fracture CPT

  • 26735 (open treatment phalangeal shaft fracture, proximal or middle phalanx finger or thumb, includes internal fixation, each)
  • 26727 (percutaneous skeletal fixation of unstable phalageal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each)

CRPP/ ORIF Hand Fracture Indications

  • Displaced metacarpal and phalangeal fracture

CRPP/ ORIF Hand Fracture Contraindications

  • Medically unstable patients
  • Active infection

CRPP/ ORIF Hand Fracture Alternatives

  • Splinting / buddy tape

CRPP/ ORIF Hand Fracture Pre-op Planning

CRPP/ ORIF Hand Fracture Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Phalangeal Shaft Fracture CRPP Technique

  • Belsky MR, J Hand Surg 1984;9Am:725
  • 0.045 (1.1mm) K-wires generally used. Consider 0.062in(1.6mm) for larger bones(metacarpal); 0.035in(0.9mm) for smaller bones (pediatric fx).
  • Closed reduction under c-arm guidance.
  • one or more intramedullary or two crossed K-wires.
  • K-wires must not cross at the fracture site.
  • K-wires are left in until fracture callus in visible on xray. Usually 3-4 weeks

CRPP/ ORIF Hand Fracture Complications

  • Loss of reduction
  • Delayed union
  • Malunion
  • Nonunion
  • Tendon adhesion / stiffness
  • Nerve or vascular injury
  • Infection
  • Painful hardware

CRPP/ ORIF Hand Fracture Follow-up care

  • Post-op /Initial: Splint. Elevation.
  • 7-10 Days: xray to ensure reduction is maintained. Continued splint, activity modifications. Immobilize as few joints as necessary. Begin ROM as soon as fixation strength with allow.
  • 6 Weeks: Remove k-wire, wean from splint use as soon as callus is visible on xray. Continue activity modifications. Agressive ROM.
  • 3 Months: Resume full activities. Assess ROM. Consider flexor/extensor tenolysis if tendon adhesions fail to improve.
  • 1Yr: assess outcomes / follow-up xrays.

CRPP/ ORIF Hand Fracture Outcomes

CRPP/ ORIF Hand Fracture Review References

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