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4Wire fixation

As the middle phalanx has a comparatively flat dorsal surface, it is sometimes difficult to drill a transverse hole.

Alternative: Insert screw

As the middle phalanx has a comparatively flat dorsal surface, it is sometimes difficult to drill a transverse hole.
As an alternative for anchoring the cerclage wire, a screw can be inserted approximately 1 cm from the fracture line. Follow standard screw inserting technique, including drilling and measuring. The screw must engage the far cortex. The screw head must protrude just enough for the wire to find anchorage.