Transmetacarpal intramedullary K-wire fixation of proximal phalangeal fractures

The management of unstable phalangeal fractures has been associated with significant morbidity. Percutaneous transmetacarpal intramedullary Kirschner wire fixation of proximal phalangeal fractures has been described as a useful technique. We present a retrospective review of 35 digits in 24 patients with unstable fractures of the proximal phalanx treated using this technique between 1985 and 1995. Outcome measures, including radiological adequacy of reduction, total active range of motion, development of joint contracture, grip strength, and digital grip strength, were assessed. Good or excellent results were obtained in 76% of fractures (19 of 25) that were treated and followed. Thirty-two percent of digits (8 of 25) treated developed a proximal interphalangeal joint flexion contracture. Flexion contracture averaged 18.1 deg at the involved joints. Seven secondary procedures were required in 6 patients. Major complications noted during the study included loss of reduction with rotational deformity in four digits, and one nonunion. The use of skeletal traction devices was associated with three of the major complications observed. These devices should not be used concurrently on or adjacent to any digit treated by intramedullary pinning. We conclude that transmetacarpal axial Kirschner wire fixation is a technically simple method of treating unstable proximal phalangeal fractures, and good or excellent results can be obtained in the majority of appropriately selected patients.