Secondary Procedures after Closed Reduction Percutaneous Pinning versus Open Reduction Internal Fixation of Phalanx Fractures: A Large Database Analysis.

Abstract

Background: While functional and patient-reported outcomes are similar for closed reduction percutaneous pinning (CRPP) and open reduction internal fixation (ORIF) of phalanx fractures, controversy exists regarding optimal fixation choice. In this study, we tested the null hypotheses that there is no difference in (1) percentage of patients undergoing secondary procedures within 2 years, (2) therapy utilisation and (3) total costs following CRPP and ORIF of phalanx fractures. Methods: Using an administrative claims database, we identified patients undergoing CRPP or ORIF of phalanx fractures from 2011 to 2020. Secondary procedures assessed within 2 years after CRPP or ORIF included phalanx osteotomy, tenolysis, irrigation and debridement, metacarpophalangeal joint arthrodesis and interphalangeal joint arthrodesis or arthroplasty. We calculated therapy utilisation at 6-month intervals after surgery and total cost of care at 90 days post-procedure. Multivariable logistic regression models were used to evaluate the association between choice of surgical fixation and incidence of secondary procedures, adjusting for age, sex, region, insurance and Elixhauser comorbidity index. Results: The composite incidence of secondary procedures was 3.1% after CRPP and 4.7% after ORIF (p < 0.001). Within 2 years after CRPP, fewer patients had tenolysis (odds ratio [OR] = 0.57 [95% confidence interval (CI): 0.52-0.63]), interphalangeal joint arthrodesis (OR = 0.51 [95% CI: 0.41-0.62]) or interphalangeal joint arthroplasty procedures (OR = 0.58 [95% CI: 0.38-0.87]). Patients who underwent CRPP had increased therapy utilisation, but similar 90-day total cost of care. Conclusions: CRPP for phalanx fractures is associated with a lower incidence of subsequent procedures compared to ORIF. Further studies are needed to compare CRPP with ORIF for phalanx fractures while accounting for specific fracture patterns as confounders, which was a limitation of this study. Level of Evidence: Level III (Therapeutic).