OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF CONDYLAR FRACTURES

Indications

• Unstable dislocated intra-articular condylar fractures (Fig. 6.12).

Pre-operative planning

Clinical assessment

• Local pain and swelling.

• Assess and document neurovascular status of finger.

• Assess and document axial or rotational dislocation.

Radiological assessment

• Standard anteroposteriorandlateral radiographsofthe finger.

Operative treatment

Anaesthesia

• Brachial plexus block, intravenous regional anaesthesia or general anaesthesia.

• At induction, administer prophylactic antibiotic as per local hospital protocol (e.g. 3rd generation cephalosporin).

Table and equipment

• Hand surgery instrumentation set.

• Hand small-fragment implant system.

• K-wires 1.0-1.2 mm.

• A radiolucent armtable.

• An upper armtourniquet.

• An image intensifier.

Table set up

• The instrumentation is set up on the side of the operation.

• Image intensifier is fromthe front side of the armtable. Check for adequate visualization in 2 planes prior to draping.

Patient positioning

• Supine, pronated armon armtable.

Draping, surgical approach and implant Positioning

• Place tourniquet at upper arm.

• Prepare the skin over elbow, forearm, wrist and hand with usual antiseptic solutions (aqueous/alcoholic povidone-iodine).

• Apply adherent drape circularly above the elbow, so free motion of the elbow is possible.

• Tourniquet after exsanguination.

• Skin incision via a dorsal ‘S’ or ‘Z’ approach to the metacarpophalangeal or interphalangeal joint. In combined fractures the skin incision is via the wound.

• Incision of the extensor tendons.

• Open joint.

• Reduce fracture under direct vision.

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