A Simple Phalangeal External Fixator Using Kirschner Wires and Locking Balls: No Need for Cement or Rubber Bands

The currently available phalangeal external fixators are either commercial and not universally available or made of Kirschner wires and a linkage mechanism such as rubber bands and cement. They are difficult to assemble and difficult to adjust after application. This paper presents an external fixator made of Kirschner wires and locking balls (better known by their commercial name: Jurgan Balls) that is easily assembled on demand in the operating room. The fixator can be applied statically as well as dynamically allowing motion across the interphalangeal joint. I have applied this fixator in a variety of fracture patterns in a total of 14 patients: 11 phalangeal fractures and 3 metacarpal fractures. The fixator was solid and maintained reduction in all phalangeal fractures. Two thumb metacarpal fractures were adequately fixed. One fourth metacarpal fracture failed fixation during surgery and required a different method of fixation. There was no loss or reduction of any of the fractures in the postoperative period. There were no nonunions and no need for second-stage surgeries. All fixators were removed in the clinic without anesthesia. The described external fixator is made of components that are readily available in most operating rooms. It does not require the use of cement or rubber bands. It allows adjustment during surgery and maintains the reduction throughout the postoperative period. It may be a useful tool for open and/or highly comminuted fractures and fracture subluxations of the proximal and middle phalanges as well as the thumb metacarpal.