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Tips and Pearls

Sterile Adhesive Tape as an Isolation Device in Phalangeal Fracture Fixation

Haji Yakob, Mohammad MRCS, MBBS*; Badge, Ravindra FRCS, MSc, MRCS, DNB, MS, MBBS

Author Information
doi: 10.1097/BTO.0000000000000348
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Abstract

SUMMARY

Sterile adhesive tape (OP-Tape; Molnlycke Health Care, Goteborg, Sweden) can be utilized to isolate single digits in closed fracture fixation. This technique is simple, cost-effective, and minimizes radiation exposure.

BACKGROUND

Phalangeal fractures are common injuries in the upper limb. The mechanism of injury can be stratified by age and is frequently associated with trauma. Fracture pattern and level of injury predicts deformity. Indications for surgical management of phalangeal fractures include instability of the fracture, intra-articular involvement, and comminution. Fluoroscopy is typically used during surgery to assess fixation and reduction. Radiation exposure from fluoroscopy can have a potential accumulated risk of up to a quarter of the annual radiation dose limit to the surgeon.1

TECHNIQUE

The principle of surgical treatment is to achieve stable anatomic reduction and allow early range of motion. Different techniques are described depending on the level of involvement and severity of fracture. A preferred and cost-effective method for fixation for simple fractures is percutaneous stabilization with Kirschner wires.2,3

Fracture reduction is achieved with longitudinal traction and sometimes in combination with a reduction manuver. We describe the use of sterile adhesive tape to isolate the involved digit by keeping the involved digit extended while securing the remaining digits in a closed fist using the adhesive tape (Figs. 1–3). The advantages of this technique are that it simultaneously isolates the operative field for more accurate fluoroscopic images and also reduces radiation exposure to uninvolved digits and the surgeon.

FIGURE 1
FIGURE 1:
Schematic of how to apply sterile adhesive tape (Op-Tape).
FIGURE 2
FIGURE 2:
Percutaneous fixation demonstrating using adhesive tape to isolate remaining fingers.
FIGURE 3
FIGURE 3:
Percutaneous fixation demonstrating ease of obtaining intraoperative images.

DISCUSSION

We feel that this simple technique facilitates closed phalangeal fracture fixation without significant additional (GBP 0.80 per tape). It can also reduce radiation exposure to the patient and surgeon. This technique can potentially be used for multiple digits and for open fixation techniques as well.

REFERENCES

1. Zyluk A, Puchalski P, Szlosser Z, et al. Exposure of the surgeon’s hands to radiation during hand surgery procedures. Ortop Traumatol Rehabil. 2014;16:595–604.
2. Cheah AE, Yao J. Hand fractures: indications, the tried and true and new innovations. J Hand Surg AM. 2016;41:712–722.
3. Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008;16:586–595.
Keywords:

adhesive tape; traction device; phalangeal fracture

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