DOI QR코드

DOI QR Code

Analysis of Bone Fixation Methods in Digital Replantation

  • Lee, Seung Woo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Lee, Dong Chul (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Kim, Jin Soo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Roh, Si Young (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital) ;
  • Lee, Kyung Jin (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital)
  • Received : 2016.07.19
  • Accepted : 2016.11.02
  • Published : 2017.01.20

Abstract

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.

Keywords

References

  1. Komatsu S, Tamai S. Successful replantation of a completely cut-off thumb. Plast Reconstr Surg 1968;42:374-7. https://doi.org/10.1097/00006534-196810000-00021
  2. Kleinert HE, Jablon M, Tsai TM. An overview of replantation and results of 347 replants in 245 patients. J Trauma 1980;20:390-8. https://doi.org/10.1097/00005373-198005000-00005
  3. Tamai S. Twenty years' experience of limb replantation: review of 293 upper extremity replants. J Hand Surg Am 1982;7:549-56. https://doi.org/10.1016/S0363-5023(82)80100-7
  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;67:611-9. https://doi.org/10.2106/00004623-198567040-00017
  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.
  6. Chung-Wei C, Yun-Qing Q, Zhong-Jia Y. Extremity replantation. World J Surg 1978;2:513-24. https://doi.org/10.1007/BF01563690
  7. Jones WW. Biomechanics of small bone fixation. Clin Orthop Relat Res 1987;(214):11-8.
  8. Hoffmann R, Buck-Gramcko D. Osteosynthesis in digital replantation surgery. Ann Chir Gynaecol 1982;71:14-8.
  9. Tupper JW. Techniques of bone fixation and clinical experience in replanted extremities. Clin Orthop Relat Res 1978; (133):165-8.
  10. Gordon L, Monsanto EH. Skeletal stabilization for digital replantation surgery. Use of intraosseous wiring. Clin Orthop Relat Res 1987;(214):72-7.
  11. Coonrad RW, Pohlman MH. Impacted fractures in the proximal portion of the proximal phalanx of the finger. J Bone Joint Surg Am 1969;51:1291-6. https://doi.org/10.2106/00004623-196951070-00006
  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.
  13. Goldner DR, Urbaniak JR. Replantation. In: Green DP, editor. Green's operative hand surgery. 5th ed. Philadelphia: Elsevier/Churchill Livingstone; 2005. p.1569-86.
  14. Goldner DR, Urbaniak JR. Replantation. In: Green DP, Wolfe SW, editors. Green's operative hand surgery. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2011. p.877-88.
  15. Mardini S, Chen KT, Wei FC. Replantation of digits. In: Moran SL, Cooney WP, editors. Master techniques in orthopaedic surgery: soft tissue surgery. Baltimore: Lippincott Williams and Wilkins; 2009. p.483-98.
  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):184-94.
  17. Whitney TM, Lineaweaver WC, Buncke HJ, et al. Clinical results of bony fixation methods in digital replantation. J Hand Surg Am 1990;15:328-34. https://doi.org/10.1016/0363-5023(90)90118-B
  18. Lamphier TA. Improper reduction of fractures of the proximal phalanges of fingers. Am J Surg 1957;94:926-30. https://doi.org/10.1016/0002-9610(57)90084-3
  19. Morrison WA, McCombe D. Digital replantation. Hand Clin 2007;23:1-12. https://doi.org/10.1016/j.hcl.2006.12.001
  20. Rahn BA, Gallinaro P, Baltensperger A, et al. Primary bone healing. An experimental study in the rabbit. J Bone Joint Surg Am 1971;53:783-6. https://doi.org/10.2106/00004623-197153040-00020
  21. Van Oosterom FJ, Brete GJ, Ozdemir C, et al. Treatment of phalangeal fractures in severely injured hands. J Hand Surg Br 2001;26:108-11. https://doi.org/10.1054/jhsb.2000.0486
  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;43:159-68. https://doi.org/10.2106/00004623-196143020-00001
  23. Littler JW. Metacarpal reconstruction. J Bone Joint Surg Am 1947;29:723-37.

Cited by

  1. Ring Avulsion Digital Replantation Utilizing a Cannulated Axial Screw for Bone Fixation vol.7, pp.8, 2017, https://doi.org/10.1097/gox.0000000000002352
  2. Intramedullary fixation with bioabsorbable and osteoconductive hydroxyapatite/poly-L-lactide threaded pin in digital replantation vol.54, pp.3, 2017, https://doi.org/10.1080/2000656x.2020.1738239