Restricted accessResearch articleFirst published online 2016-9
Intramedullary headless screw fixation for fractures of the proximal and middle phalanges in the digits of the hand: a review of 31 consecutive fractures
We present the results of 26 patients with 31 consecutive displaced or unstable extra-articular fractures of the base and shaft of the proximal and middle phalanges of the digits of the hand, treated over a period of 12 months with an intramedullary headless compression screw and early mobilization with no splinting. All fractures healed with no major complications. Only one patient, who had a pathological fracture through an enchondroma, required a tenolysis to improve the mobility of the finger. This technique seems to be technically simple, effective and with few drawbacks.
American Society for Surgery of the Hand. The hand, examination and diagnosis. 3rd Edn. New York, Churchill Livingstone, 1990.
2.
BartonN. Internal fixation of hand fractures. J Hand Surg Br. 1989, 14: 139–42.
3.
BorbasPDreuMPoggettiACalcagniMGiesenT. Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study. J Hand Surg Eur. 2016, 41: 683-687.
4.
del PiñalFMoraledaERuasJSde PieroGHCerezalL. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am. 2015, 40: 692–700.
5.
DhamangaonkarACPatankarHS. Antegrade joint-sparing intramedullary wiring for middle phalanx shaft fractures. J Hand Surg Am. 2014, 39: 1517–23.
6.
EberlinKRBabushkinaANeiraJRMudgalCS. Outcomes of closed reduction and periarticular pinning of base and shaft fractures of the proximal phalanx. J Hand Surg Am. 2014, 39: 1524–8.
7.
FaruquiSSternPJKiefhaberTR. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am. 2012, 37: 1342–8.
8.
FusettiCDella SantaDR. Influence of fracture pattern on consolidation after metacarpal plate fixation. Chir Main. 2004, 23: 32–6.
9.
HenryMH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008, 16: 586–95.
10.
HornbachEECohenMS. Closed reduction and percutaneous pinning of fractures of the proximal phalanx. J Hand Surg Br. 2001, 26: 45–9.
11.
HortonTCHattonMDavisTR. A prospective randomized controlled study of fixation of long oblique and spiral shaft fractures of the proximal phalanx: closed reduction and percutaneous Kirschner wiring versus open reduction and lag screw fixation. J Hand Surg Br. 2003, 28: 5–9.
12.
JoshiBB. Percutaneous internal fixation of fractures of the proximal phalanges. Hand. 1976, 8: 86–92.
13.
KurzenPFusettiCBonaccioMNagyL. Complications after plate fixation of phalangeal fractures. J Trauma. 2006, 60: 841–3.
14.
LuWWFurumachiKIpWYChowSP. Fixation for comminuted phalangeal fractures. A biomechanical study of five methods. J Hand Surg Br. 1996, 21: 765–7.
15.
MerleMDautelG. La main traumatique - 1. L’urgence. Paris, Masson, 1992: 54–6.
16.
OuelletteEADennisJJLattaLLMilneELMakowskiAL. The role of soft tissues in plate fixation of proximal phalanx fractures. Clin Orthop Relat Res. 2004, 418: 213–8.
17.
PageSMSternPJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998, 23: 827–32.
18.
PunWKChowSPSoYC. Unstable phalangeal fractures: treatment by A.O. screw and plate fixation. J Hand Surg Am. 1991, 16: 113–7.
19.
ten BergPWMudgalCSLeibmanMIBelskyMRRuchelsmanDE. Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am. 2013, 38: 322–30.
20.
TrevisanCMorgantiACasiraghiAMarinoniEC. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg. 2004, 124: 675–80.
21.
van OnselenEBKarimRBHageJJRittMJ. Prevalence and distribution of hand fractures. J Hand Surg Br. 2003, 28: 491–5.
22.
WeissAP. Intramedullary Herbert screws for treatment of phalangeal nonunion. Tech Hand Up Extrem Surg. 1997, 1: 41–7.
