Transartecular external

fixation - wrist
Dr Jayesh
Principles
• used as a temporary or definitive
treatment in simple or complex
distal forearm fractures.
• Specific considerations: the 4
mm (small) external fixator
system is commonly used and
may be combined with the 8 mm
(medium) system.
Indications

• Temporary stabilization in polytrauma/ unfit patient

• Instability
• Open fracture
• Unacceptable shortening or dorsal inclination
• Extension of fracture into diaphysis
• Local soft-tissues compromised for plating
• Axial impaction
Pin insertion (wrist)
Complications with pin insertion
• Injury to extensor tendons
• Injury to the superficial branch of the radial nerve
• Metacarpal fracture
 Pin insertion (wrist)
Precautions minimize the risk of these
complications:
• Knowledge of the anatomy and
specific landmarks for pin insertion
• Larger surgical incisions (1 cm over
the second metacarpal, longer
incision over the radius), instead of
stab incisions
• Blunt dissection to the bone
• Predrilling prior to insertion of the
pins
Landmarks for pin insertion into the second metacarpal

• The distal pin should be inserted proximal to

the transition of the metacarpal head into the
shaft.

• The more proximal pin is inserted distal to

transition of the shaft into the metacarpal
base.

• The pins should obtain a good hold in both

cortices.
• An eccentric position of a pin
may weaken the metacarpal,
leading to fracture.
• The extensor tendon hood must
not be transfixed with the distal
metacarpal screw.
• To avoid this complication, the
index metacarpophalangeal
(MCP) joint should be passively
flexed 90° so that the extensor
hood moves slightly distally, and
the tendons are pulled in an
ulnar direction.
• In the frontal plane, the pins
should be inserted at an angle of
30°-40° in relation to the sagittal
plane to avoid transfixing the
extensor tendon/hood.
Pin insertion in the radial shaft

• The proximal two pins should be

inserted proximal to the muscle
bellies of abductor pollicis
longus (APL) and extensor
pollicis brevis (EPB)
• and should not penetrate them.
Pin insertion in the radial shaft
• Proximal to these muscles, the
radial shaft can be palpated
through the skin between the
bellies of the extensor digitorum
communis (EDC) and extensor
carpi radialis longus/brevis
(ECRL/ ECRB) over 3-4 cm.
• This is the preferred area for
proximal pin insertion in the
radial shaft.
Pin insertion in the radial shaft
• The pins are inserted
perpendicular to the transverse
section of the radius
Reduction and fixation
• Longitudinal traction is applied on the
thumb and index finger or the distal
partial frame to reduce the fracture.
• Additional maneuvers may be
necessary depending on the specific
fracture pattern.
• Pressure from the dorsal side of the
carpus may be helpful to restore volar
tilt of the distal radius joint surface.