One of the major problems in reconstructive surgery of the hand, whether it be traumatic or elective, is adequate fixation of the injured part. This fixation should be non-space-taking and nonirritating to already traumatized tissues. Another criterion to be met is the institution of early mobility of uninjured segments of the hand and the reinstitution of mobility of the injured part as soon as skeletal structures are stabilized and soft tissues have healed. The third criterion to be observed is the prevention of postoperative hematoma and edema. This last problem I have met only by the use of an adequate, carefully applied pressure dressing. A cast permits, and even encourages, capillary oozing and is difficult to apply uniformly while attempting to maintain the position of injured parts.
Kirschner-wire fixation of phalanges, metacarpals, and carpals has proved an excellent solution to this problem, and one which has fulfilled the criteria noted
CORDREY LJ. Intramedullary "Pull-Out" Wire Fixation in Surgery of the Hand. AMA Arch Surg. 1957;75(6):979–984. doi:10.1001/archsurg.1957.01280180111016
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