A mini external fixator for hand and finger fractures constructed from readily available materials.

Phalangeal and metacarpal fractures with severe commi- nution and/or soft tissue compromise can present a challenge for the orthopedic surgeon. Maintaining viability of the soft tissues while providing rigid fixation of bony injuries is the goal when treating these injuries. Commercially available mini external fixators can help to achieve these goals. However, these devices are costly and are not always available when the surgeon needs them. In this technique study, we discuss the implementation of a mini external fixator using readily available implements in the operating room that is efficient, cost effective, and easy to apply. HISTORICAL PERSPECTIVE The principles for external fixation of long bone fractures are widely accepted, especially in cases of soft tissue loss and polytrauma. Formal open reduction and internal fixation of metacarpal and phalangeal fractures may lead to stiffness, requires soft tissue dissection which can be extensive, and is associated with costly implants. 1,2 The principles of external fixation have therefore been applied to the treatment of metacarpal and phalangeal fractures and multiple versions of mini external fixators for hand and finger fractures exist. 3-12 Phalangeal and metacarpal fractures can be difficult injuries to treat, especially when associated with soft tissue and tendon or neurovascular injuries. External fixation of hand fractures is an option for patients with these injuries and avoids wide exposures and resultant limitations in postoperative range of motion. Multiple versions of mini external fixators are available for use including commercially developed implants and implants made from materials available in the operating room. An external fixator that is low profile with adequate rigidity to treat a fracture and is made of items commonly found in an orthopedically equipped operating room is advantageous. The fixator described herein possess a number of advantages compared with commercially available devices in that it is radiolucent, low profile, allows for a multitude of different pin placements, and is cost effective. It carries the same complication risks as other fixators and has equal postoperative outcomes. Here, we describe a technique used in patients treated with an external fixator constructed from Kirschner wires, polymethylmethacrylate and readily available cement application systems. INDICATIONS/CONTRAINDICATIONS Patients with unstable fractures of the phalanges or metacar- pals are considered candidates. Open injuries or cases of infection associated with fracture are not contraindicated. The fixator works well for fractures on border digits, but can be modified in application for use in central digits. Fracture fragments that are too small to be captured by a K-wire would limit the use of the fixator. Relative contraindications include multiple phalanx and/or metacarpal fractures such that there are physical limitations for placement of the device. SURGICAL TECHNIQUE The affected extremity is prepped and draped in the usual sterile manner. Mini c-arm radiography is then used to visualize fracture fragments and perform a closed reduction. Next, a commercially available cement fun tube is opened for use as the bar of the external fixator. Some systems have different diameter of tubes for use. Although any size will work for this application, the smaller diameter tubes make lower profile fixators. The tube's usage should be planned such that the connector to the cement ''gun'' is distal to the hand. This prevents the large connector used in most systems from interfering with the hand during application and also allows the ''gun'' to be connected to the tube with less difficulty.