Modified non-transarticular K-wire external fixation versus traditional transarticular pinning for bony mallet finger: a prospective comparative cohort study
In brief
Modified K-wire fixation had 15% complications versus 48% with traditional pinning
In this prospective, nonrandomized study of 120 adults, complications at 1 year were reported in 15% of patients treated with joint-sparing K-wire fixation, compared with 48% after traditional pinning across the finger joint. The modified approach also showed better early function and faster recovery, but a single-center comparison cannot establish that the technique caused these benefits.
- Journal
- Journal of plastic surgery and hand surgery (Q2)
- Published
- 19 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Weigang Zhu, Jiashi Song, Haibo Zhou, Huaguo Tang, Jingjing Bao, Yuanjie Gu
- PMID
- 42895203
- DOI
- 10.2340/jphs.v61.46985
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 25 October 2026): Comparative hand-surgery outcomes for bony mallet finger
Abstract
BACKGROUND: Traditional transarticular distal interphalangeal joint (DIPJ) pinning for bony mallet fingers risks stiffness and iatrogenic cartilage injury. This study compared a modified non-transarticular K-wire external fixator with traditional transarticular pinning for surgically treated bony mallet finger. METHODS: This single-center prospective nonrandomized comparative cohort study included 120 adults with acute bony mallet finger. Sixty patients underwent traditional transarticular DIPJ pinning, and 60 underwent modified non-transarticular K-wire external fixation. The primary outcome was overall postoperative complications, including pin tract infection, joint stiffness, loss of reduction, nail deformity, or radiographic degenerative change assessed at 1 year. Secondary outcomes included operative time, hardware removal time, bone union time, DIPJ motion, Crawford grade, pain, QuickDASH score, and return-to-work time. Logistic regression was used to identify predictors of overall complications. RESULTS: Baseline demographic and injury characteristics were comparable between groups. Overall complications were significantly less frequent after modified fixation than after traditional fixation (15.0% vs 48.3%, p < 0.001). The modified technique markedly reduced joint stiffness and nail deformity. It was also associated with shorter operative time, earlier hardware removal, faster bone union, lower extension lag, greater maximum DIPJ flexion, better Crawford grade distribution, lower pain and QuickDASH scores, and earlier return to work. In multivariable analysis, traditional fixation remained independently associated with higher complication risk. CONCLUSION: Modified non-transarticular K-wire external fixation was associated with fewer complications and better early functional recovery than traditional transarticular DIPJ pinning. This joint-sparing, low-cost technique may be a useful surgical option for selected patients with bony mallet finger.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.