Arch Hand Microsurg.  2022 Sep;27(3):203-210. 10.12790/ahm.22.0025.

Comparative study on Kirschner-wire and screw fixation for intra-articular fractures of the proximal phalanx head

• Kim JS
• Lee JY
• Lee DC
• Roh SY
• Lee KJ
• Koh SH

• KMID: 2532735
• DOI: http://doi.org/10.12790/ahm.22.0025

Abstract

Purpose
This study compared screw and Kirschner-wire (K-wire) fixation for intra-articular fractures of the proximal phalanx head regarding the success of union and functional outcomes.
Methods
In this retrospective study, we enrolled patients with closed intra-articular fractures of the proximal phalangeal head treated between January 2011 and December 2021. Patients with open wounds, tendon or neurovascular injuries, comminuted fractures, or middle phalangeal fractures were excluded. Patients’ demographics, bone union, proximal interphalangeal (PIP) joint range of motion (ROM), grip power, and complications were collected and analyzed. The percentage of intra-articular surface involvement and the number of bone fragments were also analyzed in relation to the functional results.
Results
Among 41 patients, 21 were managed with screw fixation, and the remaining 20 with K-wire fixation. The mean union rate was 100% in the screw fixation group and 95.0% in the K-wire fixation group, with no statistically significant difference (p=0.488). Other functional parameters (PIP joint ROM, time to bone union, and grip power) were not significantly different between the two groups. Regardless of the treatment modality, the PIP joint ROM showed significant negative associations with the involvement of more intra-articular surfaces (p<0.001) and the presence of a greater number of bone fragments (p=0.040).
Conclusion
In intra-articular fractures of the proximal phalanx head, the treatment modality (screw or K-wire) did not affect the treatment outcome. Instead, the percentage of intra-articular surface involvement and the number of bone fragments showed significant negative associations with the PIP joint ROM after treatment.

Keyword

Proximal interphalangeal joint; Intra-articular fractures; Bone wire; Kirschner wire

Figure

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  Fig. 1. An example of the intra-articular surface assessment. The red arrows indicate the width and diameter of the entire articular surface, and the yellow arrows indicate that of the dominant (i.e. the largest) bone fragment.

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  Fig. 2. Twelve-year-old boy came with a proximal phalanx head fracture by physical fight. (A) Preoperative plain X-ray, computed tomography, and immediate postoperative X-ray follow-up with single-screw fixation. (B) Follow-up images at the 49.7th week, showing return to nearly full range of active proximal interphalangeal joint motion and X-ray showing bone union.

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  Fig. 3. Ten-year-old girl came with proximal phalanx head fracture during playing volleyball. (A) Preoperative plain X-ray, computed tomography, and immediate postoperative X-ray follow-up with double Kirschner-wire fixation. (B) Follow-up images at the 15.6th week, showing return to nearly full range of active proximal interphalangeal joint motion and X-ray showing bone union.

Reference

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