Identifying Predictors of Radiographic Distal Phalangeal Nonunion After Fingertip Replantation

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Microsurgery

Background:

• Fingertip replantation aims to restore function and appearance.
• Distal phalangeal nonunion is a potential complication after replantation.
• Kirschner wire fixation is commonly used for these procedures.

Purpose of the Study:

• To identify risk factors for distal phalangeal nonunion.
• To evaluate Kirchner wire fixation outcomes in fingertip replantation.

Main Methods:

• Retrospective analysis of 116 digits from 111 patients undergoing fingertip replantation.
• Inclusion of Tamai zones I and II replantations.
• Univariate and multivariable analyses of 15 potential risk factors.

Main Results:

• 13.8% of digits (16/116) experienced nonunion or complications at 12 months.
• The postfixation fracture gap was the sole significant predictor of nonunion (OR 3.30).
• Complications included asymptomatic nonunion, need for revision surgery, and bone resorption.

Conclusions:

• The size of the postfixation fracture gap is the primary factor influencing nonunion.
• Reducing the fracture gap during primary fixation is essential for successful bone healing.
• Optimizing fixation technique can improve outcomes in fingertip replantation.