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Complication Rates Between Intra-medullary and Other Fixation Methods for Extra-articular Metacarpal and Phalangeal Fractures
Ishan S. Patel, Nienke A. Krijnen, Nicky Don, Teun Teunis
University of Pittsburgh Medical Center
2025-01-10
Presenter: Nienke Krijnen
Affidavit:
Yes
Director Name: Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Purpose: phalangeal and metacarpal fractures are the second and third most common upper extremity fractures. The aim of this study is to compare adverse event rates between IM nail fixation, K-wires, and plate or screw fixation for extra-articular fractures of the hand.
Methods: a retrospective chart review was conducted at a tertiary care center of all adults surgically treated for extra-articular phalangeal and metacarpal fractures between January 2012 and December 2023. All IM nails and plate or screw fixations were included. IM nail patients were matched 1:3 with K-wire patients randomly based on age and sex for the final patient cohort.
Results: a total of 368 patients with 485 repairs were identified for analysis. Mean age was 41 (range 18 to 88) and majority of patients were male (70%). Overall, there were 103 fractures repaired with IM nail fixation, 282 with K-wires, and 100 with plate/screw fixation. Fractures repaired with IM nails were less likely to experience an overall adverse event (OR 0.47 [95% CI 0.33 to 0.56, p=0.023]) or require re-operation (OR 0.17 [95% CI 0.070 to 0.42, p<0.001) compared to K-wires and plates/screws. Fractures repaired with plates/screws had a lower rate of infection (OR 0.27 [95% CI 0.10 to 0.74, p=0.009] compared to K-wires. Concurrent neurovascular injury was an independent risk factor for overall adverse events, infection, or re-operation (p<0.05).
Conclusion: our results support the increasing use of IM nail fixation. Further study is required to establish potential differences in long-term functional outcomes.
