Indications for Open Reduction

Indications for Open Reduction
in Hand Injuries
• Intra-articular fractures with a small fragment.
• Severely displaced fractures.
• Highly unstable fractures.
• Multiple fractures.
• Soft tissue (e.g. tendon) interposition.
After open reduction, internal fixation is usually
done by K-wires (Figs 16.3A and B). Intraosseous
tension band circlage wiring, intramedullary
fixation, small AO plate and screws are the other
but less commonly used fixation methods.
Steps of Application of the Universal
Hand Splint—The Burkhalter Splint
• Fracture reduction of the fingers are done and
checked for stability.
• Now the hand and forearm are padded.
• First a volar slab is applied up to the level of the
proximal palmar crease with the wrist in
extension.
• A second dorsal slab is applied up to the level of
the proximal IP joint level with the MP joint in
maximum flexion.
• This splint neutralizes the intrinsics.
• Duration of immobilization: 3 to 4 weeks.
• Active movements of the IP joints should be
encouraged.