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Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures
Andrew W Hollins, MD1; Kristina Dunworth, BS2; Mithani K. Suhail Kamrudin, MD3; Tyler S. Pidgeon, MD1; Christopher Klifto, MD4; David S Ruch, MD1; Marc J Richard, MD5
1Duke University Medical Center, Durham, NC; 2Duke University Medical School, Durham, NC; 3Plastics and Reconstructive Surgery, Duke University Medical Center, Durham, NC; 4Duke Univeristy Hospital, Durham, NC; 5Orthopedic Surgery, Duke University Medical Center, Durham, NC

Introduction Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures. The introduction of intramedullary nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the collateral ligaments, joint capsule, or extensor mechanism. The goal of this study was to compare the surgical outcomes of intramedullary nail and percutaneous pin fixation in isolated proximal phalanx fractures.
Methods A retrospective review was performed at our institution between the years January 2018 and May 2022. All patients with the CPT codes (26725, 26727, 26735) for treatment of phalanx fractures during this time period were obtained. Patients that underwent fixation with intramedullary nails or percutaneous fixation for isolated extra-articular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fracture, tendon injury, intra-articular extension, fracture comminution, inadequate follow up, or injury of the thumb. Surgical outcomes including surgical site infection, bony union, time until mobilization, time until complete clearance from orthosis, number of occupational therapy visits and range of motion (ROM) of the finger joints.
Results A total of fifty patients were included in this study. Twenty-nine patients received percutaneous pin fixation and twenty-one patients underwent intramedullary nail fixation. Table 1 demonstrates the demographics and injury patterns between these two cohorts. There was no significant difference between injury patterns, injury mechanism, co-morbidities, or demographics between these two groups. Patients that underwent intramedullary nail fixation had a significantly quicker return to early motion (10.5 days vs. 27.7 days), shorter duration of orthosis treatment (28.2 days vs. 53.9 days), and fewer occupational therapy visits (6.1 visits vs. 11.3 visits). In addition, patients in the intramedullary nail fixation group had significantly improved flexion ROM at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints at three months postoperatively (Table 2).
Conclusion This study demonstrates that patients receiving percutaneous pin or intramedullary nail fixation have equivocal union and complication rates. The intramedullary nail fixation group was able to have quicker return to mobilization, leading to fewer required occupational therapy visits and improved early ROM.


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