Open reduction of volar fractures at the base of the distal phalanx

Fracture open reduction is the use of surgical methods to expose the fracture site, the correction and reduction of the fracture end; and according to the different conditions of the fracture, use a variety of internal fixation, to maintain the position after the reduction, called internal fixation. In general, after fracture reduction and reduction, multiple internal fixation is performed at the same time. Treatment of diseases: hand trauma fractures Indication 1. The fracture involves a significant displacement of the articular surface. It is not suitable for manual reduction, or if the technique fails to reset or the position cannot be maintained after the reduction (such as humeral condyle, femoral condyle, humeral condyle and ankle fracture), it should be opened and reset. The goal is to fight for anatomical reduction of the articular surface to avoid joint instability and damaging arthritis. At the same time, a strong internal fixation, such as the intercondylar fracture of the humerus, is fixed with a bone plug for early joint function exercise. 2. Fracture combined with joint dislocation of the same bone (such as femoral fracture combined with hip dislocation), due to fracture of the distal end of the dislocated joint, it is difficult to perform manual reduction. 3. A fracture of several bones or a fracture of the femur and tibia of the same limb, or multiple fractures, in order to prevent complications and facilitate the patient's movement in the bed, it may be possible to select some methods of difficulty in resetting or external fixation to maintain the fracture of the alignment. Open reduction and internal fixation. 4. There are obvious displacement of avulsion fractures, such as humeral fractures, olecranon olecranon fractures, etc., difficulty in manual reduction, it is difficult to maintain the contralateral alignment after reset. 5. There is soft tissue embedding between the two fracture ends, and the method of loosening the failure. 6. Fracture with major blood vessels or nerve damage, before the repair of blood vessels or nerves, it is necessary to perform an open reduction and restore the support of the skeleton. 7. The wounded failed to seek medical treatment in time. When he came to the hospital, he could not perform manual reduction or traction reduction treatment, and the fracture displacement was obvious, and it would affect the limb function in the future. 8. Some fractures with blood supply disorders, such as femoral neck fractures, external fixation is not conducive to maintaining reduction and healing. Internal fixation such as open reduction or manual reduction of three-wing nails should be used to firmly fix and promote fracture healing. 9. There is a significant displacement of the epiphyseal fracture, poor reduction or close contact between the two fracture ends. Contraindications 1. The general situation of the wounded is not good, or the concomitant shock, must first rescue, until the shock is stable, the general situation can be improved before surgery. 2. If there is a life-threatening head, chest or abdominal cavity and other important organ damage, it must be treated first. The treatment of the fracture should be relegated to the secondary position. Temporary external fixation can be performed first, and the fracture should be treated after the condition is stable, or non-surgical treatment can be used. Try to get a better reset as much as possible. 3. There are more than 8 to 12 hours of open wounds in the fracture. Preoperative preparation (1) To exert the subjective initiative of the patient: Before the operation, explain the treatment principle and treatment process to the patient, and encourage and stimulate the patient's will to fight the disease. (2) Enhance the body's resistance: The time of elective surgery must be when the body's resistance can bear the surgical trauma. For general surgery, it is important to strengthen rest before surgery, improve appetite, correct anemia and water and electrolyte disorders, and use necessary antibiotics to treat comorbidities. (3) Skin preparation at the surgical site: 1 Skin preparation in the ward: Partial cleansing starts 3 days before surgery, scrubbing the whole body or bathing 1 day before surgery, trimming fingers and toenails, changing sheets and clothes. Hair in the surgical area was shaved within 24 hours prior to surgery. On the day of surgery, the skin was washed once more. After drying, the skin was rubbed with 75% ethanol, and the sterile towel was wrapped and sent to the operating room. 2 Skin preparation in the operating room: The patient is placed in the operating room and placed on the operating table first. For the lower extremity surgery, the tourniquet should be tied and then sterilized. Surgical procedure 1, the ring finger puncture wound, the distal phalanx basal avulsion fracture, the proximal fracture block connected with the deep flexor tendon. The X-ray anterior piece is not easy to find the fracture piece, and the lateral piece is clearly visible. 2. The ring refers to the lateral incision of the distal interphalangeal joint to reveal the fracture end. 3. From the distal fracture segment, retrogradely through the Kirschner wire to the dorsal side of the finger, reduce the fracture under direct vision, and then pass the Kirschner wire into the proximal fracture segment and use another Kirschner wire for cross fixation. 4, X-ray film showed good fracture reduction and internal fixation. 5. Close the wound and use a plaster or plastic tray to brake to fracture healing. complication 1. Shock: Due to the strong stimulation of local bleeding and pain in the fracture, shock or pre-shock may occur. Open reduction is a surgery with more damage and more blood loss. If you do not prepare well before surgery, you will be aggravated or cause shock. Therefore, the key to preventing shock is to perform the necessary infusion and blood transfusion before and during surgery to supplement the blood volume. During the operation, blood transfusion should be performed according to the amount of blood loss. In addition, rude operations must be contraindicated to reduce damage stimuli. If a shock occurs, the operation should be temporarily suspended and the rescue should be actively carried out. 2. Incision infection: This is a serious complication of open reduction. Incision infection means infection at the fracture end (ie, suppurative osteomyelitis). After infection, localized long-term congestion, the fracture end is soaked by pus, tissue necrosis liberates a large number of decomposition products, which are not conducive to the healing of the fracture, so that the incidence of delayed healing and non-healing is greatly increased, the function of the limb is affected, and even occurs. Disabled. Therefore, the prevention of wound infection is extremely important, which is related to the success or failure of surgery and the recovery of limb function. The key to prevention is to adopt strict aseptic technique before and during surgery. In addition, it is important to pay attention to the light weight during surgery to avoid aggravating the damage. If an infection has occurred, drainage should be performed as soon as possible, and a sufficient amount of antibiotics should be given to control the infection. At the same time, the treatment of the fracture should not be abandoned, and external fixation or traction is still needed to maintain the fracture reduction. After infection, although the internal fixation has become a foreign body, it is not necessary to rush to remove it. After the acute inflammation subsides, the lesion is cleared, tissue metastasis or transplantation is performed to eliminate the wound and promote fracture healing. 3. Delayed healing and non-healing: The clinical healing time is prolonged in almost all fractures with open reduction. Such as intraoperative blood damage, fracture treatment, poor internal and external fixation, improper postoperative treatment or wound infection, it is more likely to cause delayed healing and non-healing. Therefore, we must pay attention to prevent infection, minimize tissue separation and peeling of periosteum, and operate lightly and reduce soft tissue damage to ensure adequate blood supply at the fracture end. For long-term and poorly transmitted fractures, bone grafts and periosteum grafts should be performed to promote healing. Fractures with delayed healing should be carefully analyzed to remove the cause. Non-healing fractures can only be cured by re-operation, trimming the bone ends, performing bone grafting and secure internal fixation.

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