Analysis of Bone Fixation Methods in Digital Replantation

Abstract

Background: Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation.

Methods: A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups.

Results: The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%).

Conclusions: In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

Keywords: Fingers; Fracture fixation; Replantation.

Fig. 1. Techniques of bony fixation

(A) Single K-wire. (B) Cross K-wires. (C) Double longitudinal K-wires. (D) Intraosseous wire with K-wire support. (E) Intraosseous wire.

Fig. 2. Single K-wire fixation

(A) Little finger amputation in a 52-year-old man. (B) Radiograph shows proximal phalanx amputation. (C) Immediately postoperatively, after digital replantation. (D) Radiograph shows secure fixation with a single K-wire technique. (E) Five-month postoperative radiography with posteroanterior view shows bone union. (F) Five-month postoperative radiography with lateral view shows minimal angulation.