Francisco del Piñal, MD, PhD, Eduardo Moraleda, MD, Jaime S. Rúas, MD, Guillermo H. de Piero, MD, Luis Cerezal, MD

Journal of Hand Surgery American Edition Vol. 40, Issue 4, April, Pages 692-700 – © 2015 by the American Society for Surgery of the Hand. All rights reserved.

ABSTRACT (full text pdf. below)

Minimally Invasive Fixation of Fractures of the Phalanges and Metacarpals With Intramedullary Cannulated Headless Compression Screws

Purpose To present the technique, indications, and outcomes of metacarpal and phalangeal fractures fixed with intramedullary cannulated headless screws (CHS).

Methods We retrospectively reviewed all charts of patients whose metacarpal and phalangeal fractures had been treated with intramedullary CHS in our practice. A total of 69 fractures (48 metacarpal and 21 phalangeal) were identified in 59 patients. Seventeen were open fractures. Eleven patients had multiple fractures (29 in total); of those, 21 were managed with CHS. In 4 other fractures the method was abandoned intraoperatively. The defect created by the entrance of the screw in the proximal phalanx was identified by computed tomography in 20 patients.

Results In 63 fractures a single screw was used; in 6 fractures 2 screws were used to provide stronger fixation. All patients returned to full duties or sport activities at an average of 76 days (range, 3 wk to 15 mo). At the latest follow-up (range, 5-54 mo; average, 19 mo) total active motion was on average 247º (range, 150º to 270º) for all fractures, 249º (range, 210º to 270º) for metacarpal, and 243º (range, 150º to 270º) for proximal phalangeal fractures. All fractures were healed and within acceptable radiological parameters. A comminuted basilar phalangeal fracture displaced secondarily yielding a poor functional result. Two patients required tenolysis and further procedures before the final result was achieved. The screw hole represents around 20% of the proximal phalanx distal articular surface.

Conclusions Unstable transverse fractures in the phalanx and metacarpal are amenable to single intramedullary CHS fixation. Comminuted fractures require more complex configurations. (J Hand Surg Am. 2015;40(4):692e700. Copyright © 2015 by the American Society for Surgery of the Hand. All rights reserved.)

Type of study/level of evidence Therapeutic IV.

Keywords Metacarpal fractures, phalangeal fractures, open digital fractures, intramedullary fixation, cannulated screws.

Our mid-term results are promising; however, the decision-making process and the operation are complex. The operation is not indicated when the carpals are devoid of cartilage or when the defect