Internal fixation in the hand: a review of indications and methods

Despite the infrequent need for open reduction of hand fractures, the orthopedic surgeon must be aware of the indications for open reduction and/or internal fixation and must be able to apply the different methods of fixation in the appropriate circumstances. Joint injuries, compound finger injuries, and alignment or stabilization problems with the hand skeleton may mandate some type of internal fixation. Availability of small implants and reliable one-hand operated pin drivers for placement of stabilizing wires or wire loops for interosseous fixation are definite advances in treatment of fractures of the hand. Rigid internal fixation, with plates or screws, cannot be considered a panacea, but interosseous wire loop techniques should be given more consideration for stabilization of phalangeal fractures, in view of the excellent opposition, rigidity, compression of fracture fragments, and ease of application that this method provides. This article reviews the variety of ways in which internal fixation techniques can be applied to injuries of the hand skeleton.