Percutaneous cerclage wiring technique for phalangeal fractures.

Comminuted fractures of phalanx are challenging to reduce properly. Commonly, the fragments are distracted by various ligaments as well as flexor and extensor tendons. Splints, skeletal traction, Kirschner wire, plate and screws, and cerclage wires have all been used to manage such fractures. Among these, the cerclage wires are able to effectively contain the distracting forces and maintain a proper concentric reduction of the hollow tube structure of phalangeal bones. The resulting tissue-hardware construct is stable and allows early rehabilitation. Despite the obvious mechanical advantages, cerclage wiring of phalangeal fractures require open incisions. Inevitably, this approach leads to periosteal stripping, upon which the distracting forces exaggerate the displacement of comminuted fragments and the blood supply to the injured bone is compromised. To overcome the disadvantages of open approach, the authors have devised a minimally invasive technique in which the cerclage wire is introduced using a hypodermic needle for fractures of the proximal phalanx and distal phalanx base.