Comparison Of Intramedullary Screw Fixation, K-wires, And Plating For Fixation Of Phalangeal Fractures: A Meta-Analysis
Michael F. Cassidy MD1, Rebeka Dejenie BS1, Kanad Ghosh MD1, Jignesh Unadkat MD1
1Plastic & Reconstructive Surgery, UChicago Medicine, Chicago, IL
Introduction:
•Intramedullary screw fixation (IMF) has recently gained popularity for operative management of hand fractures1
•IMF requires less dissection than plating, with quicker times to mobilization than Kirschner wires (K-wires)2,3
Objectives: Compare functional outcomes of IMF, K-wires, and plating in the fixation of phalangeal fractures
Hypothesis: IMF provides similar function outcomes to K-wires or plating
Methods:
•Systematic review according to PRISMA guidelines, querying PubMed and EMBASE for the following criteria
•Inclusion Criteria: extra-articular middle and proximal phalangeal fractures in adults treated with either IMF, K-wires, or plating
•Exclusion Criteria: pediatric populations, cadaveric studies, or lack of relevant inclusion criteria
•Primary Outcomes: Disabilities of the Arm, Shoulder, and Hand (DASH) scores, total active motion (TAM)
Analyses:
•Random effects meta-analysis of DASH scores and TAM4
•Meta-regression investigating the effect of moderators on inter-study heterogeneity4
Results:
Meta-Analysis:
•29 studies included (10 IMF, 10 K-wire, 14 plating)
•No significant difference in DASH score or TAM across all 3 surgical interventions, though IMF trended towards significantly higher TAM compared to plating
•High inter-study heterogeneity across all 3 surgical interventions
Meta-Regression:
•Length of follow-up and study sample size was significantly associated with heterogeneity in TAM from the IMF group (p = 0.0014)
•These modulators accounted for 87.3% of the observed heterogeneity
Conclusions:
•IMF yields noninferior functional outcomes compared to K-wires and plating of phalangeal fractures
•Inter-study heterogeneity was a limitation of this study, which was partially explained by sample size
Future Directions: Include secondary outcomes such as infection, malunion, and need for revision procedures
References:
1. DelPrete CR, Chao J, Varghese BB, Greenberg P, Iyer H, Shah A. Comparison of Intramedullary Screw Fixation, Plating, and K-Wires for Metacarpal Fracture Fixation: A Meta-Analysis. HAND. 2024;0(0). doi:10.1177/15589447241232094
2. Chao J, Patel A, Shah A. Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls. Plast Reconstr Surg Glob Open. 2021 Oct 26;9(10):e3895. doi: 10.1097/GOX.0000000000003895. PMID: 34712548; PMCID: PMC8547932.
3. Dohse NM, Jones CM, Ilyas AM. Fixation of Hand Fractures with Intramedullary Headless Compression Screws. Arch Bone Jt Surg. 2022 Dec;10(12):1004-1012. doi: 10.22038/ABJS.2022.64506.3102. PMID: 36721649; PMCID: PMC9846723.
4. Viechtbauer W (2010). “Conducting meta-analyses in R with the metafor package.” Journal of Statistical Software, 36(3), 1–48. doi:10.18637/jss.v036.i03.
