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FailedPhalangealandMetacarpalFractureManagement
นพ.ณัฐกุล แย้มประเสริฐ
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