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