2022, Vol. 26 ›› Issue (18): 2849-2853

Comparison of double Kirschner wire with double screw fixation in the treatment of avulsion fracture at the base of the distal phalanx

Gou Yongsheng, Ding Keyuan, Xu Shengqian, Li Haibo, Zhong Gang, Li Liang, Teng Lin   

Abstract: BACKGROUND: In recent years, miniature double screw fixation has achieved certain effects on the treatment of avulsion fracture at the base of the distal phalanx. However, by comparing miniature double screw fixation with Kirschner wire fixation, which treatment method has better curative effect is rarely reported.   
OBJECTIVE: To compare the clinical efficacy of double Kirschner wire and miniature double screw fixation in the treatment of avulsion fracture at the base of distal phalanx.
METHODS: Clinical data from 71 patients with avulsion fracture at the base of the distal phalanx who received surgical treatment at West China (Airport) Hospital of Sichuan University from January 2012 to January 2020 were retrospectively analyzed. There were 36 patients in double Kirschner wire group and 35 patients in double screw fixation group. The extensor flexor motion range, pain degree, satisfaction degree, and complications of the affected fingers were recorded. Overall therapeutic efficacy and subjective efficacy were evaluated using Crawford method and Buck-Gramcko, respectively.   
RESULTS AND CONCLUSION: Patients in the double Kirschner wire group were followed up for 6-15 months, with an average of (8.89±1.75) months, while patients in the double screw fixation group were followed up for 6-16 months, with an average of (8.77±1.70) months. There was no significant difference in visual analogue scale scores between the two groups (P > 0.05). According to the Crawford evaluation criteria, the excellent rates of the double Kirschner wire group and the double screw fixation group were 34/36(94%) and 30/35(86%), respectively. However, there was no significant difference between the two groups (P > 0.05). According to the Buck-Gramcko evaluation criteria, the excellent rate was 33/36 (92%) in the double Kirschner wire group and 31/35 (89%) in the double screw fixation group, with no significant difference (P > 0.05). The incidence of postoperative nail deformity, recurrence rate of hammer-finger deformity and incidence of incision infection in the double screw fixation group were higher than those in the double Kirschner wire group, but there was no significant difference between the two groups (P > 0.05). The incidence of suture exposure in the double screw fixation group was significantly higher than that in the double Kirschner wire group (P=0.025). The total incidence of postoperative complications in the double Kirschner wire group was lower than that in the double screw fixation group (P=0.029). To conclude, double Kirschner wire and miniature double screw fixation has the same effect in the treatment of avulsion fracture at the base of the distal phalanx with, but miniature double screw fixation has a higher incidence of complications, especially a higher proportion of suture exposure.
Key words: bone, fixation, implant, phalangeal fracture, kirschner wire, screw, tendon injury, extensor tendon