title: Safe corridors for K-wiring in phalangeal fractures.
abstract: BACKGROUND
  Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome.
  
  
  METHODS
  In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28).
  
  
  RESULTS
  47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept.
  
  
  CONCLUSIONS
  K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: C
authors.initials: C
authors.lastname: Rex
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: R
authors.initials: R
authors.lastname: Vignesh
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Javed
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Subba Chandra
authors.initials: SC
authors.lastname: Balaji
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: C
authors.initials: C
authors.lastname: Premanand
authors.affiliation: Department of Orthopaedics, Affiliated to Rex Ortho Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Syed Ashfaque
authors.initials: SA
authors.lastname: Zakki
keywords: K-wire; Phalanges of fingers; fracture fixation; fractures; hand injuries; metacarpo-phalangeal joint; phalanges; proximal interphalangeal joint