Subcutaneous vs. transcutaneous K-wires for proximal phalanx fractures: a prospective randomized trial on infection rates.

In this randomized prospective trial, we compared K-wire osteosynthesis techniques for fractures of the proximal phalanx. Between April 2021 and February 2024, 28 patients treated at the BG Trauma Center Tuebingen were divided into two groups. Both groups underwent osteosynthesis with two K-wires: in Group A, the wire ends were left transcutaneous, while in Group B, they were buried subcutaneously. Follow-up revealed a significantly lower infection rate with subcutaneous wires (5.89%) compared to transcutaneous wires (45.46%). The postoperative infection occurred within the first 6 weeks after surgery. Two patients had to undergo surgical revision changing or removing the K-wires unexpectedly. Additionally, the total active range of motion of the PIP joint in Group A was 21.85° less than in Group B. Patients also expressed a preference for subcutaneous placement of wire ends. These findings strongly support burying K-wire ends after osteosynthesis of proximal phalanx fractures.