Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 32:
Bony Fixation in Replantation
  Although this method can provide rigid fixation, it too is subject to failure. If the fracture has poor cortical contact, any force applied across the fracture must be borne by the plate and transmitted into the bone through the bone/plate interface. Micromotion at the bond/screw interface results in absorption of adjacent bone and subsequent loosening. The plate itself may bend or fracture. Recently, the Luhr system of plates and screws has been adapted for use in stabilizing hand fractures. The plates are extremely thin and have offset screw holes to make compression easy. Recent laboratory and clinical evidence has shown that these plates do well in hand fracture applications. 23


External skeletal fixation is a reliable method for maintaining bony alignment under certain replantation situations, and are applicable in proximal injuries as well as the hand. Although it is not a replacement for internal fixation implants, external fixation may serve as an adjunct in complex injuries undergoing staged debridement and reconstruction or in situations of loss of bone substance. Comminuted bone injuries can be held in anatomic alignment despite disrupted architecture. In all of these cases, uninvolved gliding structures and joints are freed for motion in therapy without disruption of bony alignment. Advantages of the external fixation techniques are as follows.


1. Application can often be carried out with a small number of tools, requiring limited additional dissection. 2. With experience, it can be performed quickly. 3. Early motion can begin. 4. The device causes minimal interference with dressing changes or surgical intervention.

Disadvantages are those related to damage of the soft tissue during pin placement, the risk of infection at percutaneous pin sites, and the difficulty in placement into distal phalanges. We seldom use this device inchildren because of limited bone sites, the small amounts of bone stock holding the pins, and the risk to epiphyseal growth centers. Adequate bone-to bone contact is necessary, by either bone recontouring or bone grafting, if external fixation is to be successful in long-term application.


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