SP10. Complication Rates Between Intra-medullary and Other Fixation Methods for Extra-articular Metacarpal and Phalangeal Fractures

PURPOSE: Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures. Intramedullary screw (IM nail) fixation is an increasingly used method for fracture fixation of the hand, providing potential benefits of early mobilization and improved functional recovery. The aim of this study is to compare adverse event rates between IM nail fixation, K-wires, and plate or screw fixation for extra-articular fractures of the hand. METHODS: A retrospective chart review was conducted at a tertiary care center of all adults surgically treated for extra-articular phalangeal and metacarpal fractures between January 2012 and December 2023. All IM nails and plate or screw fixations were included. IM nail patients were matched 1:3 with K-wire patients randomly based on age and sex for the final patient cohort. Patient charts were reviewed for demographics, mechanism of injury, injury fixation method, overall adverse events, graded adverse events (Clavien Dindo classification), infection treated with antibiotics, and re-operation. Baseline differences were assessed using chi-squared tests and one-way ANOVA. Overall adverse events, infections treated with antibiotics, and re-operations were analyzed between the fixation methods using multivariable analysis, accounting for baseline differences. RESULTS: A total of 368 patients with 485 total repairs were identified for analysis. Mean age was 41 (range 18 to 88) and majority of patients were male (70%). Overall, there were 103 fractures repaired with IM nail fixation, 282 fractures repaired with K-wires, and 100 fractures repaired with plate or screw fixation. Fractures that were repaired with IM nails were less likely to experience an overall adverse event (OR 0.47 [95% CI 0.33 to 0.56, p=0.023]) or require re-operation (OR 0.17 [95% CI 0.070 to 0.42, p<0.001]) compared to K-wires and plates and screws. Fractures that were repaired using plates and screws had a lower rate of infection (OR 0.27 [95% CI 0.10 to 0.74, p=0.009]) compared to K-wires. A total number of two fractures made it less likely to experience an adverse event (p=0.002) or infection (p=0.012), while requiring re-operation was more likely in the presence of four (p<0.001) or five (p=0.042) total fractures. Concurrent neurovascular injury was an independent risk factor for overall adverse events, infection, or re-operation (p<0.05). CONCLUSION: Our results support the increasing use of IM nail fixation. Further study is required to establish potential differences in long-term functional outcomes.