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Identifying Predictors of Radiographic Distal Phalangeal Nonunion After Fingertip Replantation

Published:August 13, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.06.028

      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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      References

        • Jazayeri L.
        • Klausner J.Q.
        • Chang J.
        Distal digital replantation.
        Plast Reconstr Surg. 2013; 132: 1207-1217
        • Goldner R.D.
        • Stevanovic M.V.
        • Nunley J.A.
        • Urbaniak J.R.
        Digital replantation at the level of the distal interphalangeal joint and the distal phalanx.
        J Hand Surg Am. 1989; 14: 214-220
        • Shim H.S.
        • Kwon B.Y.
        • Seo B.F.
        • Kwon H.
        • Jung S.N.
        A prospective randomised comparison of fixation methods in Tamai's zone I amputation.
        J Plast Reconstr Aesthet Surg. 2018; 71: 997-1003
        • Sud V.
        • Freeland A.E.
        Skeletal fixation in digital replantation.
        Microsurgery. 2002; 22: 165-171
        • Peiji W.
        • Qirong D.
        • Jianzhong Q.
        • Huayi W.
        • Kailong Z.
        • Nan Y.
        Intramedullary fixation in digital replantation using bioabsorbable poly-DL-lactic acid rods.
        J Hand Surg Am. 2012; 37: 2547-2552
        • Yanagibayashi S.
        • Nishijima A.
        • Yoshida R.
        • Sasaki K.
        • Yamamoto N.
        • Takikawa M.
        Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation.
        J Plast Surg Hand Surg. 2020; 54: 177-181
        • Whitney T.M.
        • Lineaweaver W.C.
        • Buncke H.J.
        • Nugent K.
        Clinical results of bony fixation methods in digital replantation.
        J Hand Surg Am. 1990; 15: 328-334
        • Touliatos A.S.
        • Soucacos P.N.
        • Beris A.E.
        • Zoubos A.B.
        • Koukoubis T.H.
        • Makris H.
        Alternative techniques for restoration of bony segments in digital replantation.
        Acta Orthop Scand Suppl. 1995; 264: 19-22
        • Lee S.W.
        • Lee D.C.
        • Kim J.S.
        • Roh S.Y.
        • Lee K.J.
        Analysis of bone fixation methods in digital replantation.
        Arch Plast Surg. 2017; 44: 53-58
        • Van Oosterom F.J.
        • Brete G.J.
        • Ozdemir C.
        • Hovius S.E.
        Treatment of phalangeal fractures in severely injured hands.
        J Hand Surg Br. 2001; 26: 108-111
        • Carpenter S.
        • Rohde R.S.
        Treatment of phalangeal fractures.
        Hand Clin. 2013; 29: 519-534
        • DaCruz D.J.
        • Slade R.J.
        • Malone W.
        Fractures of the distal phalanges.
        J Hand Surg Br. 1988; 13: 350-352
        • Chim H.
        • Teoh L.C.
        • Yong F.C.
        Open reduction and interfragmentary screw fixation for symptomatic nonunion of distal phalangeal fractures.
        J Hand Surg Eur Vol. 2008; 33: 71-76
        • Meijs C.M.
        • Verhofstad M.H.
        Symptomatic nonunion of a distal phalanx fracture: treatment with a percutaneous compression screw.
        J Hand Surg Am. 2009; 34: 1127-1129
        • Cheng H.S.
        • Wong L.Y.
        • Chiang L.F.
        • Chan I.
        • Yip T.H.
        • Wu W.C.
        Comparison of methods of skeletal fixation for severely injured digits.
        Hand Surg. 2004; 9: 63-69
        • Choi S.W.
        • Bae J.Y.
        • Kim S.Y.
        • Kim J.K.
        • Song J.S.
        Comparison of surgical outcomes between single versus dual K-wire fixation for unstable distal phalanx fractures.
        J Plast Surg Hand Surg. 2022; 56: 58-62
        • Henry M.
        Variable pitch headless compression screw treatment of distal phalangeal nonunions.
        Tech Hand Up Extrem Surg. 2010; 14: 230-233
        • Waikakul S.
        • Sakkarnkosol S.
        • Vanadurongwan V.
        • Un-nanuntana A.
        Results of 1018 digital replantations in 552 patients.
        Injury. 2000; 31: 33-40
        • Patradul A.
        • Ngarmukos C.
        • Parkpian V.
        Distal digital replantations and revascularizations. 237 digits in 192 patients.
        J Hand Surg Br. 1998; 23: 578-582