"Bi-cortical" periarticular K-wire fixation for displaced unstable transverse extra-articular fractures of the base of the proximal phalanx of the fingers. Issue 3 (March 2021) - Al-Qattan, Mohammad M.
Highlights: This is a retrospective study of 30 adult patients. All had fractures of the base of the proximal phalanx of the fingers. All had "bi-cortical" periarticular K-wire fixation. -Good/excellent results were obtained in 29 patients. -Indications/advantages of "bi-cortical" periarticular K-wire fixation are discussed. Abstract: Introduction: Management of unstable fractures of the proximal phalanx is a challenge. Objective: The purpose of this study is to introduce to the literature the use of "bi-cortical" periarticular K-wire fixation for displaced unstable transverse extra-articular fractures of the base of the proximal phalanx of the fingers. Patients and Methods: This is a retrospective study of 30 patients with such fractures treated by the author over the last 10 years. Demographic data were collected and surgical complications were documented. The outcome was considered excellent, good, fair and poor if the total active motion of the finger was >260 o, 250 o -259 o, 210 o - 249 o, and <210 o ; respectively. Results: The worst outcome was seen in an elderly patient who sustained multiple fractures and concurrent flexor tendon injury. The remaining 29 patients were relatively young (mean age of 29 years, range = 19 – 42 years) and sustained an isolated single fracture from a fall or a fight. Out of these 29 patients, the outcome was excellent in 27 patients and good in the remaining 2 patients. Conclusions: The "bi-cortical" periarticular k-wire fixation is best suited for transverse extra-articular fractures of the base of the proximal phalanx. The wire avoids all joints and hence, early post-operative mobilization is feasible. The technique is simple and obtains a favorable outcome in most patients. Type of study/level of evidence: Therapeutic IV