Use of Intramedullary Cannulated Headless Screws in the Treatment of Hand Fractures - An Anatomical Study on Long Fingers

Abstract

Utilización de los tornillos canulados sin cabeza intramedulares en el tratamiento de las fracturas de la mano -estudio anatomico en los dedos largos AbstractObjective To quantify the cartilaginous and tendinous lesions produced upon percutaneous introduction of intramedullary cannulated screws as osteosynthesis material in metacarpal and phalangeal fractures. Materials and Methods Seven anatomical models and one non-replanted hand were used. The measurements of 30 metacarpals and proximal and middle phalanges were taken. Cannulated screws with complete and partial threads were placed percutaneously through the metacarpal head and the proximal and middle phalanges, reproducing the actions performed in the clinic. The following measurements were performed: A) Percentage of the damaged cartilaginous area and its location. B) Damage to the extensor apparatus and its distance to the bone insertion point. C) Bone marrow size. Results (A) The percentages of the damaged areas in the metacarpals, proximal and middle phalanges were 5.7%, 13.35% and 9.62%, respectively. (B) The damage to the extensor apparatus was less than 3 mm with a 4-mm distance to the bone insertion point and (C) We have obtained the measurements of the intramedullary bone and from them, we calculated the width of the most appropriate screw. Conclusion In conclusion, the use of retrograde and percutaneous cannulated screws is a reliable technique with regard to the associated morbidity, and we present an approximation regarding the most appropriate screw for each location. ResumenObjetivo El objetivo de este estudio es cuantificar las lesiones cartilaginosas y tendinosas que se producen al introducir tornillos canulados intramedulares percutá-neos como material de osteosíntesis en fracturas de metacarpianos y falanges.

Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

“…Each of these techniques poses its own challenges and confers a risk of damage to different anatomical structures. Vegas et al 27 utilized cadaveric hands to assess osseochondral and extensor apparatus damage from retrograde insertion of screws. A 2.8 mm screw resulted in damage to 6.2% of the articular surface, while a 4.1 mm screw impacted 13.35%.…”