Skeletal fixation in digital replantation

Although the primary objective of replantation is revascularization and ultimately viability of the amputated digit(s), skeletal stabilization is an important cornerstone of the composite repair and reconstructive process. If performed rapidly and securely, anatomic (or near anatomic) fracture reduction and fixation may contribute profoundly to the protection of the revascularization and the repair or reconstruction of nerves, tendons, and integument; reliable fracture healing; functional restoration; and final outcome. Conversely, less than anatomic (or near anatomic) reduction or unreliable and insecure fixation may deter successful early revascularization and, later, good function. This article reviews the various methods of fracture stabilization that may be employed, and their advantages and disadvantages. We believe that anatomic (or near anatomic) fracture reduction, reliable and stable fracture fixation, minimal additional dissection, and early active range-of-motion exercises will have a substantial effect on both viability and functional outcome in digital replantation.