Figure 39—4. (A) Transverse wiring of proximal phalanx fracture. (B) Intraoperative, prior to tightening the wire of a P2 fracture. (C) Intraoperative, after tightening the interosseous wiring ofP2 fracture. Note: the Kirschner wire may be placed longitudinally or obliquely, according to surgeon preference.

5 mm from the fracture line. A 26-gauge (No. 0) stainless-steel wire is then passed through the holes. Keep in mind that the side you want to leave the twisted wire on is the side you start on. This is usually best when left on the non-contact side. Load a smooth 0.035-inch K wire into your driver and place it obliquely out through the dorsal cortex until the tip protrudes slightly at the fracture site. Now reduce the fracture anatomically and then advance the wire into the proximal fragment and achieve cortical contact. The wires are then twisted around each other, and using the appropriate device (surgeon choice), are tightened. Secure the loop onto the bone. The twisted end is bent so that it is not prominent, to prevent soft tissue irritation.

The periosteum is then restored and closed, followed by simple closure of the skin. The K wire remains in place and is trimmed to the appropriate length, and the tip protector is attached (Fig. 39-4).

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