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Percutaneous Versus Open Fixation for Phalangeal Fractures of the Hand: A Multi-Institutional Retrospective Cohort Study of Short- and Long-Term Outcomes
Philong Nguyen, BS
1, Joshua Wang, MS
1, Yousef Tanas, MD
2,3, Carolyn Henein, MS
1; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, (3)Alexandria University, Alexandria, Alexandria, Egypt
Introduction: Surgical fixation of phalangeal fractures in the hand is commonly performed using either open or percutaneous techniques. While percutaneous fixation may reduce soft tissue disruption and surgical morbidity, concerns remain regarding its long-term mechanical stability and healing outcomes. This study aims to compare short- and long-term postoperative outcomes between percutaneous and open fixation in patients undergoing surgery for phalangeal fractures of the hand.
Methods: We conducted a retrospective cohort study using the TriNetX Research Network, a multi-institutional database of de-identified electronic health records. Adult patients who underwent surgical fixation for phalangeal fractures of the hand between 2017 and 2023 were stratified into cohorts based on surgical approach: percutaneous versus open. Propensity score matching was performed in a 1:1 ratio, adjusting for age, sex, BMI, smoking status, diabetes, cardiovascular disease, osteoarthritis, rheumatoid arthritis, and other comorbidities. Outcomes were assessed at 90 days and 2 years postoperatively. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, with statistical significance defined as p < 0.05.
Results: At the 2-year follow-up, among patients with closed fractures, percutaneous fixation was associated with reduced risks of malunion (RR:0.39,95%CI:0.19-0.80,p=0.008), revision surgery (RR:0.35,95%CI:0.23-0.54,p<0.001), repair of nonunion or malunion (RR:0.41,95%CI:0.20-0.82,p=0.009), and amputation (RR:0.55,95%CI:0.30-0.99,p=0.042), while the rate of nonunion was not significantly different. In contrast, no significant differences in long-term outcomes were observed between groups for patients with open fractures. When analyzing the full cohort of patients with either open or closed fractures, percutaneous fixation was associated with lower risks of nonunion (RR:0.40,95%CI:0.19-0.83,p=0.011), revision surgery (RR:0.46,95%CI:0.36-0.59,p<0.001), repair of nonunion or malunion (RR:0.41,95%CI:0.28-0.60,p<0.001), and amputation (RR:0.49, 95%CI:0.39-0.63, p<0.001). However, mechanical complications occurred more frequently in the percutaneous group (RR:1.87,95%CI:1.00-3.49,p=0.047), while rates of malunion and hardware removal were not significantly different between groups.
Conclusion: In patients undergoing surgical fixation of closed phalangeal fractures of the hand, percutaneous fixation was associated with fewer short-term soft tissue complications and superior long-term outcomes, including reduced risks of revision, nonunion, and amputation. However, the increased rate of mechanical complications highlights the need for careful patient and fracture selection. These findings suggest that, for closed fractures, percutaneous fixation may be the preferred approach when clinically appropriate, but surgical planning should remain individualized. Prospective studies are needed to confirm these results and refine treatment guidelines.
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