chapter  10
10 Pages

External Fixation of the Metacarpals and Phalanges and Distraction Osteogenesis

External fixation is a minimally invasive technique by which

transfixing pins inserted into the bone are attached to a rigid

external frame as a method of stabilization of fractures and

joints. Reduction of fractures is accomplished by indirect

means (closed reduction) and maintained by distraction and

ligamentotaxis. Since the first description of an external claw-

type device for the treatment of a patella fracture by

Malgaigne in 1853, external fixation has evolved to be an

accepted and versatile treatment option for open long bone

fractures and periarticular fractures of the lower extremity. In

the upper extremity, external fixators are used for bony injuries

proximal to the carpus (1). Significant technical advancements

were made to external fixation systems in the 1960s that

permitted correction of deformities in three planes. While

this allowed for placement of transfixing pins prior to fracture

reduction and for adjustments after initial applications, these

systems were too large for practical use in the metacarpals

and phalanges.