Early Postoperative Outcomes of Surgical Fixation of Proximal Phalanx Fractures With Intramedullary Nails Versus Kirschner Wires.

Background: Kirschner wire (K-wire) and intramedullary (IM) screw fixation are accepted techniques for treatment of unstable proximal phalanx fractures, but comparative reports are lacking. This study aimed to evaluate early clinical outcomes following treatment with K-wire or IM fixation.

Methods: A retrospective review of all proximal phalanx fractures treated surgically at a single center by multiple surgeons was performed from May 1, 2019 to March 1, 2024. Inclusion criteria consisted of patients above 18 years of age with transverse or short-oblique proximal phalanx fractures, without associated soft-tissue injury or involvement of multiple digits, who were treated with IM screw or K-wire fixation. Outcomes were available for 49 patients (27 K-wire, 22 IM nail). Chart review was performed to assess range of motion (ROM) and Quick Disabilities of the Arm, Shoulder, and Hand outcomes 6 and 12 weeks postoperatively.

Results: A significant difference was found in total active motion (TAM) (207.4° vs 150.8°, P = .03) and proximal interphalangeal (PIP) joint motion (71.8° vs 54.5°, P = .04) between the IM and K-wire cohorts 12 weeks after surgery. Proximal interphalangeal motion was also significantly different (57.6° vs 34.3°, P = .03) 6 weeks after surgery with no significant difference in TAM (176.6° vs 122.1°, P = .13) at that time point. Quick Disabilities of the Arm, Shoulder, and Hand scores 12 weeks after surgery were not significantly different between the IM (M: 15.8) and K-wire (M: 28.15) groups (P = .13).

Conclusions: Total active motion and PIP joint motion were found to be significantly higher 12 weeks postoperatively following IM fixation compared to K-wire fixation for extra-articular proximal phalanx fractures.