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Comparison Of Infection Rates Between Intramedullary Nail, Wire, And Plate Fixation Of Open Metacarpal And Phalangeal Fractures
Casey Zhang, BS, Pooja Reddy, BS, Nia Buckner, BS, Sierra Short BS, Teun Teunis, MD PhD
University of Pittsburgh Medical Center
2024-01-13
Presenter: Casey Zhang
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. I certify that the work in this project entirely represents the original work of the resident.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
Removal of intramedullary (IM) nails used for metacarpal or phalanx fracture fixation in case of infection is more difficult than removal of plates and wires, potentially limiting their application in open fracture fixation due to higher expected infection rates. This study aims to compare infection rate and reoperation rate between IM nail fixation, wire, and plate fixation for open metacarpal and phalangeal fractures.
Methods:
A retrospective review was performed of adults who underwent surgical fixation of open, extra-articular phalangeal and metacarpal fractures at a single center between August 2005- September 2023. Three hundred forty-six patients met inclusion criteria. Thirty-six (10%) patients developed infection. We accounted for potential differences in baseline characteristics through multivariable analysis.
Results:
One infection occurred in the IM nail group (2.9%, 1/34), resulting in hardware removal. Infection rate for wire fixation was 12% (32/282), and 6.7% (2/30) with plates/screws. There was no difference in infection rate between fixation methods, adjusted for potential confounding variables (Odds ratio [OR] for IM nail fixation -0.98, 95% confidence interval [CI] -2.7 to 0.7, p=0.25). Similarly, there was no difference in re-operation rate for infections (OR -0.18, 95% CI -1.9 to 1.5, p = 0.9). Fragility analysis indicated nine additional infections were needed in the IM nail group for it to be associated with an increased rate of infection.
Conclusion:
Low risk of infection after IM nail placement in open metacarpal and phalanx fractures is assuring. However, our findings are limited by sample size and need confirmation in a larger study.
