Intramedullary compression screw fixation of metacarpal and phalangeal fractures

Abstract

The intramedullary headless compression screw (IMCS) technique represents a reliable alternative to percutaneous Kirschner-wire and plate fixation with minimal complications. Transverse fractures of the metacarpal shaft represent a good indication for this technique. Non-comminuted subcapital and short oblique fractures can also be treated with IMCS. This technique should not be used in the presence of an open epiphysis, infection and, most of all, in subchondral fractures, because of the lack of purchase for the head of the screw. A double screw construct is recommended for comminuted subcapital fractures of the metacarpal to avoid metacarpal shortening. IMCS can even be applied for peri-articular fractures of the proximal third of the phalanx and in some multi-fragmentary proximal and middle phalangeal fractures. Usually the intramedullary screws are not removed. The main indications for screw removal are joint protrusion, infection and screw breakage after new fracture. Cite this article: EFORT Open Rev 2020;5:624-629. DOI: 10.1302/2058-5241.5.190068

Percutaneous Retrograde Technique Using Intramedullary Headless Compression Screws for Metacarpal Fractures Under Wide-Awake Local Anaesthesia No Tourniquet

“…The long oblique fractures (>2 times the shaft diameter) and comminuted fractures are at risk of fracture displacement and shortening [12]. This percutaneous retrograde intramedullary fixation for metacarpal and phalangeal fractures has gained popularity in the last decade, and the results are promising [13][14][15][16][17][18].…”

Multiple drill hole osteotomy and Herbert screw for correcting a-2 years ring finger phalanx media malunion: A case report

“…The regular complication caused by utilization of K-wire or mini plate was stiffness, flexion contracture and extensor lag [9] . Meanwhile, recent large studies found that intramedullary fixation with headless compression screw is a reliable technique for the treatment of unstable extra-articular metacarpal or proximal and medial phalanx [9] , [10] , [11] . The small incision was made to visualize the extensor tendon in the distal phalanges.…”

Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature

“…Patterns that are nondisplaced or stable following closed reduction with minimal angulation, shortening, or malrotation can be managed with a short period of immobilization in the intrinsic plus position followed by a range of motion (ROM). 4,10 Surgical indications include open fractures, those with rotational deformity disrupting the digit cascade, unstable patterns, significantly displaced, shortened, or angulated fractures, and patients with multiple phalangeal or metacarpal fractures. 11 The technique of intramedullary screw fixation is best utilized for transverse or short oblique extra-articular fractures of the proximal or middle phalangeal neck or shaft in the index, long, ring, or small digits.…”

“…Surgical indications include open fractures, those with rotational deformity disrupting the digit cascade, unstable patterns, significantly displaced, shortened, or angulated fractures, and patients with multiple phalangeal or metacarpal fractures 11. The technique of intramedullary screw fixation is best utilized for transverse or short oblique extra-articular fractures of the proximal or middle phalangeal neck or shaft in the index, long, ring, or small digits 6,10. Certain fractures with partial articular involvement or some degree of metaphyseal or diaphyseal comminution may also be amenable to intramedullary headless screw fixation 12.…”

“…11 The technique of intramedullary screw fixation is best utilized for transverse or short oblique extra-articular fractures of the proximal or middle phalangeal neck or shaft in the index, long, ring, or small digits. 6,10 Certain fractures with partial articular involvement or some degree of metaphyseal or diaphyseal comminution may also be amenable to intramedullary headless screw fixation. 12 This technique also works well in the setting of a phalangeal nonunion (Figs.…”