Hypodermic needle fixation without fluoroscopy versus k-wire fixation with fluoroscopy for distal phalangeal fractures:
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ORIGINAL ARTICLE
Hypodermic needle fixation without fluoroscopy versus k‑wire fixation with fluoroscopy for distal phalangeal fractures: a comparative study Kjell Van Royen1 · Tuna Ozyurekoglu1 · Carlos A. Lozano‑Garza1 · Donald Graham1 Received: 17 July 2020 / Accepted: 23 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Distal phalanx fractures are frequently encountered in our daily practice. They are often caused by crush injuries and are the most frequent work-related hand fractures. Different types of fixation have been proposed for displaced fractures. Methods A retrospective study was performed on two fixation types. Twenty-four distal phalanx fractures were treated with k-wire fixation with fluoroscopic control in a main operating room setting. Twenty-five distal phalanx fractures were treated with hypodermic needle fixation without fluoroscopic control in an emergency treatment room setting. Clinical and radiological data were collected on fracture type, fracture healing and complications. The cost of both types of surgery was assessed. Results No significant difference in healing time, union, delayed union and non-union was found between the two groups. Loosening was significantly more frequent in the hypodermic needle group, without affecting clinical or radiographic outcome. No infections were encountered in both groups. Surgery performed in the emergency treatment room reduced the cost with 9000 dollars when compared to surgery performed the main operating room. Conclusion Treatment of displaced distal phalanx fractures with hypodermic needle fixation yields good results. Performing this procedure in a treatment room is safe and might reduce operative time, institutional costs and radiation exposure for both surgeon and patients. Keywords Distal phalangeal fracture · P3 fracture · Fingertip injury · Hypodermic needle · Treatment room
Introduction Distal phalanx fractures are the most frequent fractures encountered in the hand [1]. They are often caused by crush injuries and account for up to 50% of hand fractures after work injuries [2, 3]. Fractures can be classified based on their location as tuft fractures, shaft fractures or intra-articular fractures [4]. Although many papers have been published on intra-articular mallet finger fractures and jersey finger fractures, little evidence can be found on the treatment of adult tuft fractures and shaft fractures. Nonoperative treatment is * Tuna Ozyurekoglu [email protected] Carlos A. Lozano‑Garza [email protected] Donald Graham [email protected] 1
Christine M. Kleinert Institute for Hand and Microvascular Surgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202, USA
the norm for nondisplaced fractures. For displaced fractures, Al-Qattan reported both conservative and surgical treatment [5]. Ugurlar et al. proposed the term Seymour-type fracture, in analogy to the pediatric epiphyseal fracture; they claimed better results with operative fixation compared to conserva
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