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Comparison Of Intramedullary Screw Fixation, K-wires, And Plating For Fixation Of Phalangeal Fractures: A Meta-Analysis
Michael F. Cassidy, MD, Rebeka Dejenie, BS, Kanad Ghosh, MD, Jignesh Unadkat, MD.
UChicago Medicine, Chicago, IL, USA.
Purpose: Intramedullary screw fixation (IMF) has recently gained popularity for operative management of phalangeal fractures. We aim to compare the functional outcomes of phalangeal fractures treated with IMF, K-wires, or plating.
Methods: Systematic review of PubMed and Embase was conducted according to PRISMA guidelines by three independent reviewers. Inclusion criteria included extra-articular middle and proximal phalangeal fractures in adults treated with either IMF, K-wires, or plating. Outcomes of interest were total active motion (TAM) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Exclusion criteria included pediatric populations, cadaveric studies, or lack of relevant inclusion criteria. A random effects meta-analysis evaluated outcomes of interest.
Results: The initial search retrieved 1,377 articles. 303 duplicates were removed, yielding 1074 for title and abstract screening. 142 studies underwent full text review and 28 of these (9 IMF, 8 K-wires, 11 plating) were finally included. There were no significant differences between the three operative interventions for DASH scores. Likewise, TAM was not significantly different across interventions, though IMF trended towards significantly higher TAM compared to plating.
Conclusions: IMF can yield similar functional outcomes compared to K-wires or plating of phalangeal fractures. IMF offers high operative efficiency without the need for prolonged immobilization. Subsequent analyses will focus on meta-regression to parse out inter-study heterogeneity, as well as include additional outcomes such as infection, malunion, and grip strength.
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