Name of the Procedure:

Percutaneous Skeletal Fixation of Distal Phalangeal Fracture, Finger or Thumb
Common Names: Pinning, Finger Fracture Repair

Summary

This procedure involves the stabilization and alignment of a broken distal phalanx (the bone at the end of the finger or thumb) using pins inserted through the skin.

Purpose

Percutaneous skeletal fixation is performed to:

• Correct fractures of the distal phalange to ensure proper healing.
• Maintain proper alignment of the bone fragments.
• Reduce pain and restore the full function of the finger or thumb.

Indications

This procedure is indicated for:

• Displaced fractures of the distal phalanx in the finger or thumb.
• Open fractures or fractures with significant soft tissue injury.
• Patients who fail to maintain alignment with non-surgical treatments like splinting.

Preparation

Prior to the procedure, patients may need to:

• Fast for a certain period, usually 6-8 hours, if general anesthesia is used.
• Adjust medications as instructed by the healthcare provider.
• Undergo diagnostic tests like X-rays to assess the fracture.

Procedure Description

1. Anesthesia: Local anesthesia is commonly used; however, general anesthesia may be given in some cases.
2. Incision and Pin Insertion: A small incision is made near the fracture site. Pins are inserted through the skin and into the bone to hold the fragments in place.
3. Alignment: The bones are carefully aligned, and additional imaging may be used to ensure proper placement.
4. Stabilization: Pins are secured and the incision is closed. A splint or cast is applied to protect the area.

Tools used include:

• Surgical pins (Kirschner wires)
• Imaging equipment (X-ray or fluoroscopy)
• Standard surgical instruments (scalpel, clamps)

Duration

The procedure typically takes about 30-60 minutes.

Setting

This surgery is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

Common risks include:

• Infection at the pin site
• Pin migration or loosening
• Damage to surrounding nerves or blood vessels

Rare but serious complications:

• Nonunion or malunion of the bone
• Loss of function or stiffness
• Anesthesia-related complications

Benefits

• Proper healing and alignment of the fractured bone
• Pain relief
• Restoration of hand function Typically, benefits can be seen within a few weeks as the bone starts to heal.

Recovery

Post-procedure care includes:

• Keeping the splint or cast dry and clean
• Limited use of the affected hand
• Pain management with prescribed medications
• Follow-up appointments to monitor healing and pin removal Full recovery can take several weeks to a few months depending on the severity of the fracture.

Alternatives

Alternative treatments may include:

• Non-surgical methods like splinting or casting.
• Open surgical fixation if percutaneous method is not suitable. Pros of alternatives:
• Non-surgical methods avoid risks related to surgery and anesthesia. Cons:
• May result in poorer alignment and longer healing time compared to percutaneous fixation.

Patient Experience

During the procedure, the patient will be anesthetized and should not experience pain. Post-procedure, some discomfort and swelling are expected, but these can be managed with pain medications. Most patients can return to normal activities gradually, following physician guidelines.