So There’s A Metal Pin In Your Finger Now What

Transcript

Welcome And Episode Focus

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Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm Carl Petito. I'm an occupational therapist and a board certified hand therapist. I specialize in the rehabilitation of orthopedic conditions that affect the finger the fingertips through the shoulder. Today I want to talk about something that's quite interesting and a little bit mysterious. I have a lot of patients that come in after they've had a finger fracture or a fracture within their hand, and a pin is holding the fracture together so we'll heal optimally in excellent alignment. And the pins, there's a lot of questions. Can I move with the pins in place? Should I just rest it until the pins are removed? How do the pins get removed? Should I do wound care at the pin site where the pin enters the skin? Should I put antibiotic whitement? Should I wash this soap and water? A lot of questions. So let's really simplify that today. And I want to share with you what I do in the clinic with my patients under the direction of the surgeons who I work with and what's optimal in the world of hand therapy, hand rehabilitation. In the specialty, there's a lot of details, but let's simplify it. And I would like you to know what you can expect when you go to your hand therapist. It's really important that you be seen by a provider who specializes in this because it is highly detailed, and you can't just watch a video and say, oh well, that's what I'm gonna do with my hand. So you so you have to get into the clinic, all right? But let's demystify a few different things. So what the hand surgeons like to do with the with the pin, the pin is highly polished stainless steel, and there's different diameters. This is the widest diameter pin or wire. It's technically called a Kirschner wire or a K wire for short, and it's designed to be pushed into the bones to stabilize the fracture site or the site where the bone is broken, so it will heal in excellent alignment. The surgeon places this into a gun that looks like a drill, it spins it, and there's a very sharp point, and there's bevels so that it will spin into the bone. And the surgeon uses what's called a fluoroscope. So, like a, for example, a big C arm, that there would be an X-ray component on the top and bottom, and they can take snapshots of X-ray and see where is the pin inside the bone. So let's so let me give you an example. One very common injury is called a boxer's fracture. So the boxer's fracture, you know, ideally anybody should punch with the first two knuckles because those bones are primarily aligned well with the end of the radius on the thumb side. This is the thumb side. Over here, there is quite a space and it's not as stable. So these bones on the small finger side of the hand commonly fracture the small finger and the ring finger, and that's nicknamed Boxer's Fracture. So, for example, if there is a fracture line, for example, on the small finger that might be oblique, might be at an angle, the surgeon would take one pin and drive it through the side of this bone on the small finger side of the hand into the next bone for stability, and then take another pin and drive it through, ideally, through the let's say the line, for example, is the fracture line is oblique like this at an angle, they would get perpendicular to the fracture line and drive it into the other the other bone, neighboring bone for stability. And then that gets trimmed off, so it might be sticking out like this. Let me show you on my hand. So it might be sticking out maybe oh an inch or half an inch, and then that would be trimmed off in a ball called the jurgan ball would be placed on the tip so that it wouldn't, if you bump someone else or yourself, it wouldn't poke anyone's eye out or cause any other damage, and that's just held in place with a Allen screw. So if you see someone else's hand or even your hand where a pin might be sticking out and there's a ball at the end, that's what that is. So, how does it come out? It comes out very, very easily. Sometimes these even fall out as healing takes place. But when the surgeon pulls this out at a follow-up visit, after the x-rays showed excellent healing, and you don't need the pin to stabilize it any longer, they take off the ball and just grasp onto this with pliers and just slip it right out. It's not very uncomfortable. It's some patients say, Oh, they just felt a little bit of a burn. A lot of patients don't feel anything because it's highly polished stainless steel and it doesn't really grasp the bone real hard as there's not a lot of friction. Now, where the pin enters the skin, that technically could be an access point for bacteria to travel through the into the hole that is pierced into the skin. So I started seeing patients with this about four days post-operative, especially for a finger, because the fingers are very very unforgiving and they stiffen up very rapidly. So let's talk about a finger fracture. So let's let's look at the long finger, the middle finger, and let's say there's a um there's a fracture trans totally transverse, something fell, or they fell, or they punched something, or hit something with their hand, um, and there's a fracture across. Well, the surgeon might place a pin down through that bone, um, and then the pin might be sticking out back here. And and oftentimes a surgeon has to perhaps enter back here in the hand and drive that pin through the shaft of that bone, and the pin might be sticking out way back here. So, what I do in the office, of course, I look at the x-ray on the computer and I look at the the x-ray and see exactly where that pin is, and I read the surgeon's operative report, say what joints are immobilized, if any, what joints are free. So I'm gonna verify that this big knuckle is free. The pin is not traveling through the joint, it's only going through this first bone of the middle finger. So on post-operative day four or five, I'm manually stabilizing that first bone that's fractured, and I'm starting to start range of motion and actually showing teaching the patient how to do it at home, how to start bending the big knuckle, for example, and then bending the middle knuckle while self-stabilizing that. Now, what I do for patients is I take a video of them doing the exercises on their telephone, so they have a video of exactly how to do it. And that's for patients who can you know easily very well follow the instructions, and all of the home program exercises, the way I practice is there's not a lot of exercises to do. We get them consolidated into just a few, very targeted, and exercises that work multiple things at once, so there's not a long list of things to do. Okay, so he said early range of motion is the key. Alright. Moving on, what about taking care of the wound where the pin goes into the skin? One of the main surgeons I work with, his saying is the solution to pollution is dilution. So let's any pollute the pollution, of course, would be bacteria, viruses, you know, anything get in there that we don't want to be in there. Wash normally with soap and water. I have my patients wash normally with soap and water, very gentle, controlled, in the sink, soap and water, rinse it off real well, pat it dry. Then after it's dry, we add antibiotic ointment. They can just use a cotton swab or something, and add a nice uh liberal amount of antibiotic ointment around the base of the pin. And all of this is given in writing to the patient. Uh, we even give them antibiotic ointment to use. And then after wound healing, which is by the way, in the fingers and the hand, because there's a lot of blood flow, wound healing occurs in about five weeks. So, usually after five weeks post-operative, the pin can be removed. And then maybe it's still you know, it has to be protected a little bit, and the patient will continue wearing the custom orthosis that I fabricated. So that also occurs on postoperative day four or five. I would remove the post-operative big bulky dressing, get rid of that, and then fabricate a nice custom splint appropriately to stabilize the fracture site or multiple fracture sites, stabilize those and around the pin, and then I also have to make it so that the custom orthosis can be easily removed and put back in place. Sometimes what I'll do is, for example, I'll fabricate a custom splint, but then it'll have a protective hood over the top so that if patients are you know banging into something, that plastic protective hood would not uh would protect this pin so that way it wouldn't be jostled, jostled around. It's actually quite a smooth process. It's a very nice, simple, uh direct way to stabilize a fracture, allow early movement. Because by the way, another benefit of early movement is increased blood flow, because when our joints move and and we're it helps squash blood around and get and it also helps um get the swelling out. And swelling for the for the inflammatory phase of wound healing in the first 10 to 14 days is crucial because it's the lymphatic system is bringing the lymphatic fluid there and carrying away bacteria. So it's a that's a a very important piece of the immune system, is your lymphatic system, which is vessels throughout your body carrying fluid. So the I'm not in a huge hurry to for the first 10 to 14 days to get all that swelling out of there. The body's doing its doing its part to get to move the bacteria out, and then as soon as clinically possible, we get the swelling out to allow for easier and further motion. So let's recap. The keys are early motion, and we can do that with the surgeons placing a pin. I'm seeing patients four to five days post-operative, removing the post-operative dressing, putting a protective splint that patients can remove for performance of their home program, remove for washing, normally with soap and water, applying antibiotic ointment around the base of the pin. And then after there's enough adequate healing, the pin gets pulled and it just slips out real easy because it's highly polished stainless steel. So I hope that takes some of the mystery out of pins, you know, sticking out of people's wrists and hands, and uh it is a great tool. And with the hand therapist, you know, working closely with the hand surgeon, it's a great partnership. Well, thank you for watching. Thank you for subscribing to the hand to shoulder solution, and thank you for sharing this with people who you feel would benefit from this as well. The hand to shoulder solution, we are the solution to your pain. Thank you.