Hay Robyn Aik Siew, Tay Shian Chao
Duke-NUS Graduate Medical School, Singapore.
Department of Hand Surgery, Singapore General Hospital, Singapore.
J Hand Surg Am. 2015 Nov;40(11):2160-7. doi: 10.1016/j.jhsa.2015.06.125. Epub 2015 Oct 1.
To compare K-wire and screw fixation of distal phalanx (DP) fractures with respect to union and functional outcome.
This retrospective study identified patients with DP fractures from a clinic registry taken from 2007 to 2013. Clinical data collected included patient demographics, range of motion (ROM), removal of implant (ROI), and complications. Radiographic data collected included fracture type, location, configuration, fracture displacement, and radiographic union. Statistical analysis was done using a chi-squared test for categorical variables and paired Student's t test for continuous variables.
A total of 172 patients with DP fractures were seen in our clinic between 2007 and 2013. Of these, 141 patients were managed conservatively and 31 patients had surgery for 33 DP fractures, of which 12 had K-wire and 21 had screw fixation. Mean union incidence for screw was 100% compared with 83% for K-wire. Time to union was 2.4 months for screw fixation compared with 4.1 months for K-wire fixation. ROM for screw fixation was significantly better (60°) compared with K-wire fixation (45°). ROM for non-transarticular K-wire (46°) was similar to transarticular K-wire (44°). ROI was performed in 52% of patients with screw fixation. Other than fingertip tenderness, which resolved after ROI, no other complications were noted.
Our study showed that the union incidence and time to union for screw fixation were comparable to those for K-wire fixation. Screw fixation of DP fractures resulted in greater distal interphalangeal joint motion compared with K-wire fixation but required removal in half of cases.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
比较克氏针与螺钉固定治疗远节指骨（DP）骨折的愈合情况及功能结局。
本回顾性研究从2007年至2013年的临床登记中确定DP骨折患者。收集的临床数据包括患者人口统计学资料、活动范围（ROM）、内植物取出（ROI）及并发症。收集的影像学数据包括骨折类型、位置、形态、骨折移位及影像学愈合情况。对分类变量采用卡方检验，对连续变量采用配对学生t检验进行统计分析。
2007年至2013年期间，我院共诊治172例DP骨折患者。其中，141例患者接受保守治疗，31例患者因33处DP骨折接受手术治疗，其中12例采用克氏针固定，21例采用螺钉固定。螺钉固定的平均愈合率为100%，而克氏针固定为83%。螺钉固定的愈合时间为2.4个月，而克氏针固定为4.1个月。螺钉固定的ROM（60°）明显优于克氏针固定（45°）。非经关节克氏针固定的ROM（46°）与经关节克氏针固定（44°）相似。52%接受螺钉固定的患者进行了内植物取出。除了内植物取出后消失的指尖压痛外，未发现其他并发症。
我们的研究表明，螺钉固定的愈合率和愈合时间与克氏针固定相当。与克氏针固定相比，DP骨折的螺钉固定可使远侧指间关节活动度更大，但半数病例需要取出内植物。
研究类型/证据水平：治疗性III级。
