Name of the Procedure:

Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation

• Commonly known as: Pinning of a finger or thumb fracture

Summary

This is a procedure where a surgeon uses pins to stabilize a broken bone in the finger or thumb. The pins are inserted through the skin without making a large incision. This method helps ensure that the bone heals correctly and quickly.

Purpose

• Condition Addressed: Unstable fractures of the phalangeal shaft in the proximal or middle phalanx.
• Goals: To stabilize the broken bone, ensure proper alignment, facilitate healing, and restore function to the affected finger or thumb.

Indications

• Severe pain, swelling, and deformity in a finger or thumb secondary to an unstable fracture.
• Inability to use the affected digit.
• X-ray confirmation of an unstable fracture in the proximal or middle phalanx.

Preparation

• Pre-procedure Instructions: Patients may need to fast for a certain period before the procedure, usually about 6-8 hours if general anesthesia is used.
• Medications: Adjustments to certain medications may be necessary. For example, blood thinners might need to be stopped temporarily.
• Assessments: Preoperative imaging studies like X-rays or sometimes CT scans to assess the fracture.

Procedure Description

1. Local anesthesia or regional block is administered to numb the area, or general anesthesia may be used.
2. The skin is cleaned and sterilized to prevent infection.
3. The fracture is manipulated into the correct alignment.
4. Pins are inserted percutaneously (through the skin) to hold the bone fragments in place.
5. A final X-ray is taken to confirm proper placement.
6. The pins are secured, and the area is bandaged.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the complexity of the fracture.

Setting

The procedure is usually performed in a surgical center, hospital, or outpatient clinic.

Personnel

• Orthopedic surgeon or hand surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the pin sites.
• Pin migration or loosening.
• Damage to surrounding nerves or blood vessels.
• Non-union or malunion of the fracture.
• Stiffness or loss of motion in the affected digit.

Benefits

• Stabilization and proper healing of the fracture.
• Improved function and range of motion in the finger or thumb.
• Pain relief and quicker return to daily activities.

Recovery

• Post-Procedure Care: Keep the pin site clean and dry. Follow-up visits for pin removal are essential.
• Physical Therapy: May be recommended to restore motion and strength.
• Recovery Time: Full recovery can take several weeks to a few months.
• Restrictions: Limit use of the affected hand as advised by the doctor. Avoid heavy lifting or vigorous activities during the healing period.

Alternatives

• Conservative Management: Splinting or casting without surgery, but this may not be suitable for unstable fractures.
• Open Reduction and Internal Fixation (ORIF): More invasive surgery involving plates and screws.
• Pros and Cons: Percutaneous fixation is less invasive with faster recovery but may require additional procedures if pins loosen.

Patient Experience

• During the Procedure: Patients may feel pressure or movement but should not feel pain if adequate anesthesia is used.
• After the Procedure: Some pain and swelling are common. Pain management typically involves over-the-counter pain relievers or prescribed medications if necessary.
• Comfort Measures: Elevation of the hand and ice packs can help with swelling and discomfort.