Antegrade Kirschner Wire Transfixation of Interphalangeal and Metacarpophalangeal Joint in a Comminuted Thumb Proximal Phalangeal Fracture.

Abstract

Comminuted proximal phalangeal fractures of the thumb are inherently unstable injuries requiring surgical fixation to provide stability and restore function. Current fixation methods include plate and screw fixation, which is associated with stiffness (in 64% of cases), extensor lag, and hardware complications requiring further operations. Moreover, intramedullary screws carry the risk of cartilage damage and fracture displacement during insertion. These modalities requiring extensive soft tissue dissection correlate with poor functional outcomes due to fibrosis and vascular disruption. A simplified surgical technique was presented through a case of open comminuted thumb proximal phalangeal fracture managed with antegrade intramedullary Kirschner wire transfixation of both the metacarpophalangeal joint (MCPJ) and interphalangeal joint. This approach acknowledges the biomechanical reality that thumb function primarily relies on carpometacarpal joint mobility, with the MCPJ contributing substantially less to functional opposition, making temporary MCPJ immobilization well tolerated. Extended stabilization is critical, as evidenced by a documented case report showing loss of reduction between 9 and 14 weeks postoperatively, even with a rigid fixation method. The technique presented offers several advantages: minimal soft tissue disruption preserving vascularity essential for healing, no pin tract infection despite nonburied wire fixation, simplified removal without additional anesthesia, and economic benefits through reduced operating time and the absence of expensive implants. Radiographic union was achieved by 16 weeks, with good functional recovery and no complications. This technique represents a valuable balance between stability requirements and soft tissue preservation, particularly in open injuries where extensive surgical approaches may be contraindicated.