Analysis of Bone Fixation Methods in Digital Replantation

 

 Permissions and Reprints

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.

This article was presented as a free paper at the 6th Research and Reconstructive Forum on April 7, 2016 in Daegu, Korea.

Publication History

Received: 19 July 2016

Accepted: 02 November 2016

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• REFERENCES

• 1 Komatsu S, Tamai S. Successful replantation of a completely cut-off thumb. Plast Reconstr Surg 1968; 42: 374-377
  CrossrefGoogle Scholar
• 2 Kleinert HE, Jablon M, Tsai TM. An overview of replantation and results of 347 replants in 245 patients. J Trauma 1980; 20: 390-398
  CrossrefPubMedGoogle Scholar
• 3 Tamai S. Twenty years' experience of limb replantation: review of 293 upper extremity replants. J Hand Surg Am 1982; 7: 549-556
  CrossrefPubMedGoogle Scholar
• 4 Urbaniak JR, Roth JH, Nunley JA. et al. The results of replantation after amputation of a single finger. J Bone Joint Surg Am 1985; 67: 611-619
  CrossrefPubMedGoogle Scholar
• 5 Nunley JA, Goldner RD, Urbaniak JR. Skeletal fixation in digital replantation. Use of the “H” plate. Clin Orthop Relat Res 1987; (214) 66-71
  PubMedGoogle Scholar
• 6 Chung-Wei C, Yun-Qing Q, Zhong-Jia Y. Extremity replantation. World J Surg 1978; 2: 513-524
  CrossrefPubMedGoogle Scholar
• 7 Jones WW. Biomechanics of small bone fixation. Clin Orthop Relat Res 1987; (214) 11-18
  PubMedGoogle Scholar
• 8 Hoffmann R, Buck-Gramcko D. Osteosynthesis in digital replantation surgery. Ann Chir Gynaecol 1982; 71: 14-18
  PubMedGoogle Scholar
• 9 Tupper JW. Techniques of bone fixation and clinical experience in replanted extremities. Clin Orthop Relat Res 1978; (133) 165-168
  PubMedGoogle Scholar
• 10 Gordon L, Monsanto EH. Skeletal stabilization for digital replantation surgery. Use of intraosseous wiring. Clin Orthop Relat Res 1987; (214) 72-77
  PubMedGoogle Scholar
• 11 Coonrad RW, Pohlman MH. Impacted fractures in the proximal portion of the proximal phalanx of the finger. J Bone Joint Surg Am 1969; 51: 1291-1296
  CrossrefPubMedGoogle Scholar
• 12 Touliatos AS, Soucacos PN, Beris AE. et al. Alternative techniques for restoration of bony segments in digital replantation. Acta Orthop Scand Suppl 1995; 264: 19-22
  Google Scholar
• 13 Goldner DR, Urbaniak JR. Replantation. In: Green DP. Green's operative hand surgery. 5th ed. Philadelphia: Elsevier/Churchill Livingstone; 2005: 1569-1586
  Google Scholar
• 14 Goldner DR, Urbaniak JR. Replantation. In: Green DP, Wolfe SW. Green's operative hand surgery. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2011: 877-888
  Google Scholar
• 15 Mardini S, Chen KT, Wei FC. Replantation of digits. In: Moran SL, Cooney WP. Master techniques in orthopaedic surgery: soft tissue surgery. Baltimore: Lippincott Williams and Wilkins; 2009: 483-498
  Google Scholar
• 16 Urbaniak JR, Hayes MG, Bright DS. Management of bone in digital replantation: free vascularized and composite bone grafts. Clin Orthop Relat Res 1978; (133) 184-194
  PubMedGoogle Scholar
• 17 Whitney TM, Lineaweaver WC, Buncke HJ. et al. Clinical results of bony fixation methods in digital replantation. J Hand Surg Am 1990; 15: 328-334
  CrossrefPubMedGoogle Scholar
• 18 Lamphier TA. Improper reduction of fractures of the proximal phalanges of fingers. Am J Surg 1957; 94: 926-930
  CrossrefPubMedGoogle Scholar
• 19 Morrison WA, McCombe D. Digital replantation. Hand Clin 2007; 23: 1-12
  CrossrefPubMedGoogle Scholar
• 20 Rahn BA, Gallinaro P, Baltensperger A. et al. Primary bone healing. An experimental study in the rabbit. J Bone Joint Surg Am 1971; 53: 783-786
  CrossrefPubMedGoogle Scholar
• 21 Van Oosterom FJ, Brete GJ, Ozdemir C. et al. Treatment of phalangeal fractures in severely injured hands. J Hand Surg Br 2001; 26: 108-111
  CrossrefPubMedGoogle Scholar
• 22 Boyd HB, Lipinski SW, Wiley JH. Observations on non-union of the shafts of the long bones, with a statistical analysis of 842 patients. J Bone Joint Surg Am 1961; 43: 159-168
  CrossrefGoogle Scholar
• 23 Littler JW. Metacarpal reconstruction. J Bone Joint Surg Am 1947; 29: 723-737
  PubMedGoogle Scholar