Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 32:
Bony Fixation in Replantation
  FIG. 32-10. Bony fixation has been performed with perpendicular intraosseous wires, predrilled into the amputated digits. The perpendicular wires reduce rotation and provide moderate compression, and in our unit, they have had the lowest nonunion rate.

FIG. 32-11The PIP joint of the long finger has been fused at 30 degrees with a similar technique after removal of the articular cartilage, as seen in x ray.


A 22-year-old mover caught his dominant hand beneath the power tailgate of a moving van, resulting in a crushing, devascularizing injury to the proximal phalanges of four fingers. The patient arrived 5 1/2 hours after the original injury, and revascularization was begun after 6 hours of warm ischemia.

FIG. 32-12 Fixation was applied as rapidly as possible with K-wires. Despite prolonged ischemia, all digits survived after an eight-hour procedure.

FIG. 32-13. X ray shows fixation.

FIG. 32-14. Multiple other methods have been described for fixation in digital replantation. Lister has popularized the combined use of single transverse intraosseous wire paired with an obliquely placed K-wire, which limits rotation and provides compression. The intraosseous wire can be placed away from rotational axis to provide a tension band function.


FIG. 32-15. Cassel describes a technique using a single intraosseous wire placed in a tetrahedral pattern through perpendicular drill holes and suggests incorporating the avulsed collateral ligaments of periarticular replants.

FIG. 32-16. The tension band principle can also be applied externally, using fine wire twisted around K-wires placed across the fracture. A figure-of-8 pattern has been applied to the dorsal cortex to oppose the distracting forces occurring during motion.

FIG. 32-17. We have used plate fixation rarely in replantation, but have found it effective in correction of nonunion.


A 22-year-old man suffered a transmetacarpal amputation of his nondominant hand in a quarry accident. Despite the avulsive nature of the tendon injury, the remaining structures were sharply divided and with minimal traction damage. As a manual laborer, the patient wished replantation if possible despite the prolonged reconstructive course.

FIG. 32-18. Preoperative x ray view shows the extensive tendon injury.

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