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Early Postoperative Outcomes of Surgical Fixation of Proximal Phalanx Fractures with Intramedullary Nails vs. Kirschner Wires
Gregory J Schmidt, MD
1; Craig Dent, DO, MS
2; Andy Nguyen, BS
2; Jason Nydick, DO
31Florida Orthopaedic Institute, Temple Terrace, FL; 2Foundation For Orthopaedic Research and Education, Tampa, FL; 3Florida Orthopaedic Institute, Tampa, FL
Introduction: Kirschner (K-) wire and intramedullary (IM) screw fixation are accepted techniques for treatment of unstable proximal phalanx fractures, but comparative reports between the two fixation techniques are lacking. The purpose of this study was to evaluate early clinical outcomes following treatment with K-wire or IM fixation.
Methods: A retrospective review of all proximal phalanx fractures treated surgically at a single center by multiple surgeons was performed from 5/1/2019 to 3/1/2024. Inclusion criteria consisted of patients over 18 years of age with transverse or short-oblique proximal phalanx fractures, without associated soft tissue injury, or involvement of multiple digits, who were treated with IM nail or K-wire fixation. Overall, 408 patients were assessed with 77 patients eligible for inclusion. Outcomes were available for 49 of the patients eligible for inclusion (27 K-wire, 22 IM nail). Chart review was performed to assess ROM and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) outcomes 12 weeks postoperatively. Patient demographics and postoperative rehab protocols were also evaluated. Statistical analysis consisted of Student's T Test for comparison of normal distributions and Mann-Whitney U testing between non-parametrically distributed groups.
Results: There was no significant difference in patient age between groups (p = 0.82), and the small finger was the most commonly fractured (73%) without a significant difference in frequency between groups (p=0.37). Patients treated with IM nail were immobilized a significantly shorter duration then patients treated with K-wires (p < 0.01) and were less likely to be placed in a cast or removable splint (p < 0.01). A significant difference was found in Total Active Motion (TAM) (207.4º vs. 150.8º, p= 0.03) and proximal interphalangeal (PIP) joint motion (71.8º vs. 54.5º, p = 0.04) between the IM and K-wire cohorts 12 weeks after surgery. PIP motion was also significantly different (57.6º vs. 34.3º, p = 0.03) six weeks after surgery with no significant difference in TAM (176.6º vs. 122.1, p = 0.13) at that timepoint. QuickDASH scores 12 weeks after surgery were not significantly different between the IM (Mean: 15.8) and K-wire (Mean: 28.15) groups (p. = 0.13). One K-wire patient underwent reoperation for contracture, and an IM nail patient was offered implant removal for screw backout.
Conclusion: TAM and PIP joint motion were found to be significantly higher 12 weeks post-operatively following IM fixation compared to K-wire fixation for extra-articular proximal phalanx fractures. This finding indicates a potential early benefit to IM screw fixation.
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