Purpose
This study aimed to estimate the risk factors for distal phalangeal nonunion in cases
involving Kirchner wire fixation after successful fingertip replantation.
Methods
This study retrospectively analyzed 116 digits of 111 patients, including 74 and 42
digits with replantation in Tamai zones I and II, respectively. Univariate and multivariable
analyses were performed to assess the influences of 15 independent variables on nonunion,
including age, sex, medical history of diabetes mellitus, history of smoking, injured
hand and digit, injury type (clean, blunt, and crush-avulsion), amputation type (complete
or incomplete), length of the distal bone fragment (mm), fracture type (simple or
comminuted), presence of a bone defect, length of the fracture gap after fixation
(mm), number of Kirchner wires used, evidence of venous repair, and the occurrence
of pin tract infections after fixation.
Results
At 12 months after replantation, 100 digits showed bony union and 16 (13.8%) digits
showed radiographic nonunion or equivalent complications, including 9 digits with
asymptomatic nonunion without a secondary operation, 5 that underwent an additional
operation for nonunion or a complication, and 2 with distal bone resorption. A multivariable
analysis indicated that the postfixation fracture gap was the only significant predictor
influencing nonunion (odds ratio, 3.30; 95% confidence interval, 1.92–5.68).
Conclusions
The extent of the postfixation fracture gap had the greatest influence on preventing
distal phalangeal nonunion, indicating the importance of reducing the fracture gap
in primary fixation as much as possible.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: August 13, 2022
Accepted:
June 29,
2022
Received:
December 15,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
