Distal phalanx fractures are the most common injuries of the hand, and K-wire fixation is commonly performed for unstable fractures. However, there is no consensus regarding the number of K-wires to use in bone fixation. We aimed to compare the results between single and dual K-wire pinning. This retrospective study enrolled patients who underwent K-wire pinning for unstable distal phalanx fractures, including the shaft and tuft, from June 2016 through April 2020. We divided patients into two groups based on the number of K-wires used for bone fixation (single vs. dual). Clinical and radiographic data were measured and compared between the two groups. Additionally, multivariable logistic analysis was performed to identify the risk factors for nonunion. A total of 80 patients were enrolled. Among them, 27 were managed with a single K-wire and 53 with a dual K-wire. There was no significant difference in the union rate between the single and dual K-wire groups (77.7% vs. 84.9%, respectively), but time to union was significantly longer in the single K-wire group (11.3 vs. 8.4 weeks; p = .003). The presence of a bone gap after fixation was a risk factor for nonunion. Our study showed that the union rate was comparable between single and dual K-wire pinning in distal phalanx fractures. However, dual K-wire pinning shortened the union time.

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