Arch Hand Microsurg.  2024 Jun;29(2):82-89. 10.12790/ahm.24.0009.

A comparative analysis of antegrade and retrograde Kirschner wire fixation for proximal phalanx base fractures

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

• KMID: 2556357
• DOI: http://doi.org/10.12790/ahm.24.0009

Abstract

Purpose
We aimed to determine whether the clinical outcomes of antegrade and retrograde extra-articular Kirschner wire (K-wire) pinning differed in proximal phalanx base fractures.
Methods
This retrospective study investigated 73 patients aged ≥18 years with extra-articular proximal phalanx base fractures that were treated by closed K-wire pinning between January 2014 and June 2023. Patients were analyzed according to whether the K-wire fixation was antegrade or retrograde. We analyzed demographics, injury characteristics, the number of K-wires applied, surgical duration, the interval before implant removal, and when physical therapy was started. Radiological outcomes included the amount of time required for radiographically confirmed bone union. Clinical outcomes consisted of complications, total active motion (TAM), and the Michigan Hand Outcomes Questionnaire (MHQ).
Results
We treated 29 and 44 patients using antegrade and retrograde K-wire fixation, respectively. The overall complication rate was higher in the antegrade group than in the retrograde group (13.8% vs. 9.1%), although this difference was not statistically significant. Similarly, no significant between-group differences were detected in the length of time required for bone union and implant removal, TAM, and MHQ scores.
Conclusion
Proximal phalanx base fractures were equally and effectively treated by antegrade and retrograde K-wire fixation. Therefore, the direction of K-wire fixation can be chosen based on surgeons’ preferences and experience.

Keyword

Finger injuries; Finger phalanges; Closed fractures; Fracture fixation; Kirschner wire

Figure

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  Fig. 1. (A) Anatomical structures around the proximal phalanx, with a focus on extensor mechanisms. The proximal phalanx is outlined with a dashed line. A and B indicate the insertion points for antegrade and retrograde Kirschner wire (K-wire) fixation, respectively. Blue lines and arrows show the paths and directions of K-wire advancement, respectively. CS, central slip; MPJ, metacarpophalangeal joint; PIPJ, proximal interphalangeal joint; IM, interosseous muscle; DA, dorsal aponeurosis; LB, lateral band. Image used with permission; courtesy of Makoto Tamai, MD, PhD, Director and Hand Surgeon at the West 18th Street Hand Clinic in Sapporo, Japan. (B) Radiographic demonstration of antegrade and retrograde K-wire fixation. A and B indicate the insertion points for antegrade and retrograde K-wire fixation, respectively. White lines and arrows show the paths and directions of K-wire advancement, respectively.

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  Fig. 2. Radiographs of antegrade Kirschner wire fixation. Images were obtained before surgery (A), immediately after surgery (B), and at 1 year after surgery (C). (D, E) Range of motion before surgery (D) and 1 year after surgery (E). Arrows, fracture sites of the proximal phalanx.

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  Fig. 3. Radiographs of retrograde Kirschner wire fixation. Images were obtained before surgery (A), immediately after surgery (B), and at 1 year after surgery (C). (D, E) Range of motion before surger (D) and 1 year after surgery (E). Arrows, the fracture sites of the proximal phalanx.

Reference

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