Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 32:
Bony Fixation in Replantation
  A 42-year-old architect suffered a clean amputation of his left thumb by a hand-held rotary saw. The thumb was completely transected through the proximal phalanx without joint injury.

FIG. 32-4 Early postoperative view shows restoration of the thumb position and maintenance of length. After minimal bony shortening, crossed Kirschner wires have been placed to provide fixation without joint impingement. Wires are usually drilled into the amputated part first, and then driven retrograde into the stump. Care is taken to compress the bone fragments during drilling to limit distraction caused by the second wire.

FIG. 32-05. Early postoperative x ray.


A patient sustained complete thumb amputation after a table saw accident.

FIG. 32-06. A single 0.045 inch K-wire has been driven retrograde into the proximal stump. Note the needle transfixing the flexor pollicis longus to prevent retraction. Single wires, placed either obliquely or through the medullary cavity, usually provide adequate fixation in fractures distal to the sublimis insertion, where the forces acting to deform the fracture are reduced.

  FIG. 32-07. X ray shows placement.

FIG. 32-08. Distal Zone I replantation at the level of the neck of the middle phalanx. Single K-wires crossing the distal interphalangeal joint have been used. If fusion is planned, the arthrodesis is made at approximately 15 degrees for the index finger with each more ulnar finger increased by 5 degrees.

FIG. 32-09. Although several methods provide adequate fixation, we have recently begun using a transverse 4-cortical screw in patients undergoing elective toe-to-hand transplantation. As seen in x ray, the toe metatarsal is hollowed and fitted over the stump of the remnant metacarpal shaft. A transverse 1.5 to 2.0 cm lag screw is placed to include contact with all cortices.


A 27-year-old man suffered a three-finger amputation through the proximal phalanges and the PIP joint of the long finger in a sheet-metal cutter. There was a closed dislocation of the long finger DIP joint.

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