Timing for Surgical Stabilization with K-wires after Open Fractures of Proximal and Middle Phalangeal Shaft

The optimal timing for surgical stabilization after open fractures of proximal and middle phalangeal shaft remained unclear. Total 147 patients with single open fracture in proximal or middle phalangeal shaft (arrived within 8 hours) who received K-wire fixation from June 2012 to June 2015 were included for analysis. The timing for surgical stabilization of fractures (immediate or delayed) was decided according to the surgeons’ preferences. The Michigan hand outcomes questionnaire (MHQ) scores, grip strength and total active motion (TAM) one year after the initial surgery were similar between the two groups. There was no significant difference in the incidence of tenosynovitis, bone nonunion. The overall infection rate in immediate fixation group was slightly but not significantly higher compared with the delayed fixation group (29.2% versus 20.7% P = 0.212). However, patients with both palmar and dorsal wounds who received immediate fixation had much higher infection rate compared with delayed fixation (52.6% versus 22.7%, P = 0.047). The immediate fixation could reduce costs and the period of hospitalization. Open fractures with both palmar and dorsal wounds should be treated with delayed fixation of K-wires otherwise stabilized immediately after injury.