Department of Reconstructive Surgery and Hand surgery, Azienda Ospedaliera Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
Clinical Orthopaedics, Polytechnic University of Marche, Ancona, Italy.
BMC Musculoskelet Disord. 2020 Sep 2;21(1):590. doi: 10.1186/s12891-020-03606-6.
Distal Phalanx (DP) fractures are the most common hand injuries. Bone fixation associated with soft tissue reconstruction, is often required to ensure more effective outcomes. The aim of the present study is to compare functional outcomes of DP fractures surgically treated with crossed manual drilled 23 Gauge needles vs crossed Kirschner-wires (k-wire).
Clinical data included analysis of patient demographics, range of motion (ROM), and complications. Radiographic assessment considered fracture type, location, fracture displacement, and radiographic union. Functional outcomes analysis was performed.The statistical significance was assessed at the level of probability lower than 5%.
A total of 60 patients from 2012 to 2015 were retrospectively enrolled and among them 12 patients suffering from diabetes or current smokers. A total of 60 DP fractures were treated, 32 with needles (group A) and 28 with k-wire fixation (group B). Time to union, showed in different time points, was significantly lower in group A (≤ 40 days, p = 0.023*) compared to group B. ROM of the distal interphalangeal joint at six months follow-up was 60° in group A and 40° in group B. A significant improvement was observed (p = 0.001*) in the 23 G needle treated group. Functional outcome analysis showed that VAS was significantly lower in group A compared to group B (p = 0.023*).
Our study showed that the 23 G needle yielded satisfactory results in terms of time to union and range of motion compared to k-wire fixation especially for tuft and shaft DP fractures. Therefore, should be a valid alternative to k-wire fixation in selected patients.
远节指骨（DP）骨折是最常见的手部损伤。通常需要进行骨固定和软组织重建，以确保更好的治疗效果。本研究旨在比较经皮交叉手动 23G 针与交叉克氏针（k-wire）治疗 DP 骨折的功能结果。
临床数据包括患者人口统计学、活动度（ROM）和并发症的分析。影像学评估考虑骨折类型、位置、骨折移位和影像学愈合。进行功能结果分析。统计显著性评估概率水平低于 5%。
回顾性纳入 2012 年至 2015 年的 60 例患者，其中 12 例患有糖尿病或目前吸烟。共治疗 60 例 DP 骨折，其中 32 例采用针（A 组），28 例采用 k-wire 固定（B 组）。在不同时间点，A 组的愈合时间（≤40 天，p=0.023*）明显低于 B 组。在 6 个月的随访中，远节指间关节的 ROM 在 A 组为 60°，在 B 组为 40°。在 23G 针治疗组中观察到显著改善（p=0.001*）。功能结果分析显示，与 B 组相比，A 组的 VAS 明显更低（p=0.023*）。
与 k-wire 固定相比，我们的研究表明，23G 针在愈合时间和关节活动度方面取得了令人满意的结果，尤其是在 tuft 和骨干 DP 骨折中。因此，在选择的患者中，它应该是 k-wire 固定的有效替代方法。
