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Is There a Difference in Adverse Event Rates and Range of Motion Between Fixation with Nails, Wires and Plates or Screws for Extra-articular Metacarpal and Phalangeal Fractures?
Ishan S Patel, BS
1, Nienke Anna Krijnen, MD
2, Benjamin Leslie, BS
1, Nicolas Aycardi, BS
1, Nicole L Don, AB, MA
1; Teun Teunis, MD, PhD
1(1)University of Pittsburgh Medical Center, Pittsburgh, PA, (2)University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
Introduction: Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures. Intramedullary screw fixation is an increasingly used method for fracture fixation of the hand, providing potential benefits of early mobilization and improved functional recovery. There is no consensus on the optimal treatment for extra-articular metacarpal and phalangeal fractures. We therefore asked, is there a difference between intramedullary (IM) nail, K-wire, and plate or screw fixation in (1) adverse events and (2) range of motion?
Materials & Methods: A retrospective chart review was conducted at a tertiary academic center of all adults surgically treated for extra-articular phalangeal and metacarpal fractures between January 2012 to August 2024. First, patients treated with IM-nail or plate/screw fixation were included. Then, the IM nail group was randomly matched 1:3 with patients treated with K-wires based on age and sex. Patient charts were reviewed for demographics, fixation method, overall adverse events, graded adverse events (Clavien-Dindo classification), infection treated with antibiotics, re-operation, and total active motion (TAM). This resulted in a cohort of 711 patients, having 873 repairs. Mean age was 39 (SD 16) and majority of patients were male (66%). Overall, there were 167 fractures repaired with IM nail fixation, 443 with K-wires, and 263 with plate or screw fixation. We used multi-level multivariable analysis to account for relevant baseline differences, and other potential confounders.
Results: Compared to K-wires, overall adverse events and re-operation were lower in the IM nail group (adverse events: OR 0.52 [95% CI 0.30 to 0.89, p=0.018, re-operation: OR 0.23 [95% CI 0.11 to 0.47, p<0.000]). After plate/screw fixation we found a lower rate of infections treated with antibiotics and also a lower re-operation rate (infection with antibiotics: OR 0.33 [95% CI 0.15 to 0.70, p=0.004]; re-operation: OR 0.48 [95% CI 0.26 to 0.87, p=0.016]). Fractures treated with IM-nails had greater total active motion 3 months after fixation (b-coefficient 29 [95% CI 2.7 to 56, p=0.031]) compared to K-wires.
Conclusions: Our results support the increasing use of IM nail fixation
. Any concern for increased adverse events with intra-medullary hardware seems unfounded, when compared to more time tested methods of fixation such as wires or plates/screws. Compared to K-wire fixation, IM nails might result in a faster recovery, with a quicker regain of finger motion. Our results would benefit from confirmation in a prospective randomized study.
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