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4Check alignment

At this stage, after provisional fixation, it is advisable to check the alignment and rotational correction by moving the ...

Identifying malrotation

At this stage, after provisional fixation, it is advisable to check the alignment and rotational correction by moving the finger through a range of motion.
Rotational alignment can only be judged with the fingers in a degree of flexion, and never in full extension. Malrotation may manifest itself by overlap of the flexed finger over its neighbor. Subtle rotational malalignments can often be judged by tilting of the leading edge of the fingernail, when the fingers are viewed end-on.
If the patient is conscious and the regional anesthesia still allows active movement, the patient can be asked to extend and flex the finger.
Any malrotation is corrected by direct manipulation and later fixed.