Open Distal Phalanx Tuft Fractures in Fingertip Injuries: A Retrospective Cohort Study Comparing Kirschner Wire...

Open tuft fractures of the distal phalanx are frequently associated with soft-tissue and nail-bed injuries, yet the optimal management-particularly the role of Kirschner wire (K-wire) fixation-remains controversial. This study aimed to compare clinical and functional outcomes between K-wire fixation and conservative management in patients with open distal phalanx tuft fractures.

A retrospective comparative cohort study was conducted involving 50 adult patients with open tuft fractures of the distal phalanx. Patients were divided into two groups: K-wire fixation (n = 25) and conservative management (n = 25). Outcomes assessed at a minimum of 6 months included radiological union, distal interphalangeal joint range of motion, pinch strength, pain using the visual analog scale, patient satisfaction, and complication rates.

Union was achieved in 94% of the fixation group versus 76% of the conservative group. Time to union was shorter with fixation (5.2 ± 1.1 vs 6.8 ± 1.6 weeks). At final follow-up, the fixation group demonstrated significantly better distal interphalangeal flexion range of motion (65° ± 8° vs 54° ± 10°), greater pinch strength (88% ± 6% vs 74% ± 8% of contralateral side), and lower visual analog scale pain scores (1.4 ± 0.8 vs 2.8 ± 1.2). Despite these differences, patient satisfaction was only slightly higher in the fixation group (84% vs 76%). Complications were low in both groups, with conservative management showing higher rates of delayed union and residual tenderness.

K-wire fixation may offer more reliable union and functional recovery in open tuft fractures with displaced or unstable fragments and significant nail-bed injury. However, given the retrospective design and sample size, treatment decisions should be individualized and tailored according to the type and severity of injury and patient involvement in decision making.

Therapeutic III.