Treatment of Hand Fractures with External Fixation

, University of Cruz Alta, RS Brazil; , and , University of West Virginia, Morgantown, WVa; , and , Brazil.


Medscape General Medicine. 1998;1(1) 

In This Article

Abstract and Introduction


External fixation of phalangeal fractures is a good method for osteosynthesis in certain situations. The simplicity of the surgical procedure and the minimal disruption of the normal bone architecture also make it appealing. It can be done under regional anesthesia by inserting one or two offset pins into each bony fragment. The fracture is reduced by applying traction to the finger and mobilizing the proximal and distal fragments with external pressure. After the fracture is reduced, the fixator frame can be applied. Radiograms are used to assure proper alignment. After two to eight weeks, depending on the severity of the fracture or bony grafting, the device is partially disassembled and, if union is clinically evident, is withdrawn with local anesthesia. External fixators are appropriate in cases of open, comminuted, unstable fractures. Other appropriate settings for external fixation include temporal management of fractures and length preservation of a functional digit. There are several disadvantages to external fixation, such as pin tract infection, inadequate fixation and the high cost of the devices. Five clinical cases successfully using external fixation are presented.


The combination of skeletal fractures and severe soft tissue damage presents a difficult management problem to the physician, especially in comminuted phalangeal fractures with bone defects. External fixation is a method that provides stability and good alignment of the fracture, and permits early mobilization of adjacent joints. The key advantages include the simplicity of the operative procedure, minimal disturbance of the bone biology and decreased risk of deep infection and nonunion.

This article describes five cases in which external fixation was used with good results and outlines the indications, advantages, disadvantages and technical details of this method of treatment.