Intramedullary screw versus Kirschner wire fixation of extraarticular proximal and middle phalanx fractures: a multicenter randomized controlled trial
Middle or proximal phalanx fractures
The treatment arms for this study will be operative fixation of proximal or middle phalanx fractures using IM screws versus K-wires. For IM screw fixation, the fracture will first be reduced by the surgeon using a closed technique. A small incision will then be made at the head or base of the proximal or middle phalanx. Skin and extensor mechanism will be retracted to expose the planned screw entry side. One or two IM screws of appropriate width and length based on the patient’s bony morphology and fracture pattern will then be placed in the phalanx to hold the reduction. Fluoroscopy will be used during the process. The patient will be placed in a plaster splint. For K-wire fixation, the fracture will first be reduced by the surgeon using a closed technique. One or multiple K-wires will be placed to hold the fracture reduction. Fluoroscopy will be used during the process. K-wires will be cut outside the skin and a plaster splint will be applied. The K-wires will be removed at the 4-week visit unless a post-operative infection necessitates earlier removal or clinical signs of delayed fracture healing necessitates later removal.14 For both groups, protected early range of motion will be initiated by a licensed hand therapist 1 week post-operatively and patients will be offered a thermoplastic splint during their 1-week hand therapy visit. Hand therapy and splinting will be progressed as per the hand therapists’ and the surgeons’ discretions based on clinical examination. Patient will be seen at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and 1 year post-surgery by the surgical team and hand therapy. X-rays will be performed preoperatively and at 4 weeks and 12 weeks post-surgery as per standard of care. Surgical details will also be recorded. All aspects of care provided to participants as described above is the current standard of practice except for randomization to intervention. Randomization will be performed in a 1:1 ratio using randomization in blocks o
1. Adult patients ≥18 years old 2. Scheduled for operative management of extraarticular proximal or middle closed phalanx fracture(s) at our tertiary hospital 3. Feasible to perform closed reduction 4. Able to provide informed consent and complete health-related quality of life (HRQoL) questionnaires in English
1. Other fractures that cannot be managed with IM screws or K-wires 2. Fractures affecting both hands 3. Other significant injury to the contralateral upper extremity 4. Other intraarticular fractures 5. Significant concomitant hand trauma 6. Cannot commit to 3 month follow up at our institution