Elsevier

Injury

Volume 49, Issue 2, February 2018, Pages 351-358
Injury

Cemented K-wire fixation for the treatment of shaft fractures of middle phalanges

https://doi.org/10.1016/j.injury.2017.10.012Get rights and content

Abstract

Background

The objective of this report is to introduce an external-fixation technique using the combination of K-wires and cement.

Methods

From February 2009 to January 2015, 51 patients with shaft fractures of middle phalanges were treated with cemented K-wire fixation. The mean age of patients at surgery was 41 years. The mean time interval from injury to operation was 6 ± 5.78 days. Injured digits included index (n = 18), long (n = 15), ring (n = 7), and little (n = 11) fingers. Types of fractures were transversal (n = 32), short oblique or spiral (n = 5), and comminuted (n = 14) fractures. Active range of motion of the fingers was measured. Total active motion was scored based on the American Society for Surgery of the Hand. All measurements were compared with those on the opposite fingers. Patients also reported on their satisfaction using the 100-mm visual analogue scale.

Results

At the final follow-ups of 2 years, range of motion of metacarpophalangeal joint, proximal phalangeal joint, and distal interphalangeal joint reached 97% ± 2.88, 93% ± 6.65, and 96% ± 3.22 of the opposite fingers, respectively. Based on Total active motion scoring system, we obtained 36 excellent and 15 good results. Based on VAS, patient satisfaction was 96 ± 3.44.

Conclusions

The cemented K-wire fixation is a reliable technique for the treatment of shaft fractures of middle phalanges. The technique is a minimally invasive procedure with minimal complications.

Level of evidence

Therapeutic study, Level IVa.

Introduction

Middle phalanx fractures are far more challenging to restore range of motion and function than distal and proximal phalanx fractures because of the complex anatomy along the middle phalanx [1]. After fracture, bone shortening and imbalance of the extensor mechanism occur, resulting in proximal interphalangeal (PIP) joint hyperextension and an extensor lag at the distal interphalangeal (DIP) joint. If adequate reduction cannot be achieved or the fractures are unstable, surgical treatments are indicated [2]. Currently, many surgical techniques are used, but those techniques allow early joint motion often resulting in good functional recovery [3].

Fixation using K-wire is the common procedure. Various pin configurations have been described, such as axial pining, cross-pinning methods, etc [4]. The axial pining is a simple technique that can usually be achieved by percutaneous manner, but to a large extent impedes joint motion [5]. Cross-pinning is the commonly uses method due to the advantage of stabilizing the fracture and allowing early joint motion [6]. Technically, however, percutaneous cross-pinning is usually more difficult, and pin site close to the joint increases pin tract infection during joint motion. In addition to pining, utilizing a miniature plate-and-screw system can achieve more rigid fixation, but requires extensive exposure that carries higher risks of complications, including nonunion, infection, tendon excursion and stiffness, as well as possible secondary implant removal [7]. Utilizing an external fixator has been proven to be an appropriate technique for stabilizing unstable, open fractures with severe soft-tissue injuries [8]. Owing to inherent weakness in the design of small devices, however, they are difficult to be assembled and difficult to be adjusted after application [9]. Usually, a maximum of 4 pins or screws can be installed. In order to avoid the drawback, we developed a combination of K-wires and cement to create an external fixator. The technique can be used in various patterns of shaft fractures, and more K-wires can be secured and the frame can be created arbitrarily. Owing to avoiding impediment to the joints, early range of motion (ROM) exercise can be performed.

The objective of this report is to introduce treatment of shaft fractures of middle phalanx using combined K-wires and cement. We also reported efficiency with the use of the technique.

Section snippets

Patients and methods

Statement: We have applied for registration at ClinicalTrials.gov Protocol Registration and Results System. The institutional review boards of the participating hospital approved the study. Informed consent was obtained from each patient.

From February 2009 to January 2015, 51 consecutive patients with shaft fractures of middle phalanges were selected in our hospital. Preoperative radiographs were obtained in all cases (Fig. 1). All operations were performed by the same senior hand surgeon based

Results

Patient demographic and clinical characteristics are shown in Table 1. The mean age of patients at surgery was 41 years (range, 19–60 years). The mean time interval from injury to operation was 6 ± 5.78 days. Injured digits included index (n = 19), long (n = 15), ring (n = 6), and little (n = 10) fingers. Types of fractures were transversal (n = 32), short oblique or spiral (n = 5), and comminuted (n = 14) fractures. The mean time of operation were 52 ± 17 min. Mild pin track infection occurred in 2 fingers

Disscussion

We find percutaneous cemented K-wire fixation is a reliable technique for the treatment of shaft fractures of middle phalanges. The technique is a minimally invasive procedure with minimal complications.

We find few studies on shaft fractures of middle phalanx alone, though there are many reports on combined series of metacarpal and phalangeal fractures. Middle phalangeal shaft fractures are often displaced and rotated due to their flexor tendons and fibro-osseous tunnels [14]. Closed reduction

Conclusion

The cemented K-wire fixation is a minimally invasive technique. It is reliable to achieve a rigid fixation that allows early joint motion.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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