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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Distal phalanx fractures menagement with 23 gauge percutaneous needles vs kirschner wires

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  • presenting/speaker Francesco De Francesco - Dpt. of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Letizia Senesi - Clinical Orthopeadics, Dpt. of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Andrea Marchesini - Dpt. of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Pier Paolo Pangrazi - Dpt. of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy
  • Michele Riccio - Dpt. of Reconstructive Plastic Surgery - Hand Surgery Unit, Ancona, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1239

doi: 10.3205/19ifssh0709, urn:nbn:de:0183-19ifssh07095

Published: February 6, 2020

© 2020 De Francesco et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The most common fractured bone in the hand is the distal phalanx (DP). These fractures are often managed conservatively but the presence of high comminution or articular fractures with injuries of nail beds sometimes require a surgical approach. In literature, different techniques of internal fixation were described. The aim of the present retrospective study is to make a comparison between Kirschner wires vs 23 Gauge percutaneous needles in treatment of these fractures, evaluating functional outcomes and time to union.

Methods: We performed a retrospective study in patients who had DP fractures and were treated from 2013 to 2015. Collected clinical data include patient demographic data, mechanism of injury, type of treatment, follow-up, range of motion (ROM), and complications. Patients were divided into 2 groups based on methods of fixation (Group A: K-wire; Group B: 23-G needles) and we compared their baseline demographics and final outcomes accordingly. Statistical analysis was done using t-test for paired samples in case of variables normally distributed or Wilcoxon signed-rank test in case of not-normally distributions. Statistical significance was measured at p <0.01.

Results and Conclusions: A total of 60 patients with surgical DP fractures were treated. 12 of these were excluded from the study because of diabetes mellitus type II or because they are smokers. On remaining 48 patients, 14 were female and 34 were male. 23 patients (52%) had k-wire fixation (Group A) and 25 patients (48%) had 23-G crossed needle fixation (Group B). Time to union was 51 days for group A and 39 days for Group B. The difference was statistically significant (p<0.001). At the final follow-up (six months after surgery), the average DIP joint ROM was 45° for Group A and 60° for Group B. This difference was statistically significant (p<0.001). Side effects were 1 non-union in group B and 4 non-union in group A, which required surgery.

In conclusion, the present study shows that DP fractures treated with 23 G percutaneous needles heal faster with a higher ROM, if compared to K wires. The present technique might be a valuable alternative, safe and cheaper if compared to other techniques for these fractures. However, nail bed repair and nail presence are fundamental elements to provide best clinical outcomes in patients.