Treatment of phalangeal and metacarpal fractures with intramedullary compression screws
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Published:
Nov 18, 2020
Keywords:
fracture, metacarpal, phalanx, screws, intramedullary, compression
Main Article Content
Abstract
Objective: To study the clinical and radiological outcomes of patients with extra-articular phalangeal and metacarpal fractures who were treated with minimally invasive internal fixation using retrograde intramedullary compression screws.
Materials and Methods: Prospective study in patients over 18 years of age treated for simple, transverse or short oblique, extra-articular phalangeal and metacarpal fractures between November 2016 and June 2019. The series included 47 patients and 76 fractures: 28 metacarpal bones (MC), 27 proximal phalanges (PP), 21 middle phalanges (MP). Clinical and functional outcomes were assessed with goniometry, documenting the total active range of motion (TAM). Radiological outcomes were assessed using the criteria proposedby Pun et al. All patients completed the Quick DASH questionnaire at last follow-up.
Results: The average follow-up period was 24.5 months. All study fractures average TAM was 238°, metacarpal TAM was 252°, and phalangeal TAM was 230°. Radiograph evaluation showed fracture consolidation in all cases. Average time taken to return to normal daily activities was 79 days. Average final Quick DASH score was 4.5. There were no complications nor secondary surgeries.
Conclusions: Minimally invasive internal fixation with retrograde intramedullary compression screw proved to be a highly effective option in the treatment of extra-articularphalangeal and metacarpal fractures.
Key words: Fracture, metacarpal, phalanx, screws, intramedullary, compression.Level of Evidence: II
Materials and Methods: Prospective study in patients over 18 years of age treated for simple, transverse or short oblique, extra-articular phalangeal and metacarpal fractures between November 2016 and June 2019. The series included 47 patients and 76 fractures: 28 metacarpal bones (MC), 27 proximal phalanges (PP), 21 middle phalanges (MP). Clinical and functional outcomes were assessed with goniometry, documenting the total active range of motion (TAM). Radiological outcomes were assessed using the criteria proposedby Pun et al. All patients completed the Quick DASH questionnaire at last follow-up.
Results: The average follow-up period was 24.5 months. All study fractures average TAM was 238°, metacarpal TAM was 252°, and phalangeal TAM was 230°. Radiograph evaluation showed fracture consolidation in all cases. Average time taken to return to normal daily activities was 79 days. Average final Quick DASH score was 4.5. There were no complications nor secondary surgeries.
Conclusions: Minimally invasive internal fixation with retrograde intramedullary compression screw proved to be a highly effective option in the treatment of extra-articularphalangeal and metacarpal fractures.
Key words: Fracture, metacarpal, phalanx, screws, intramedullary, compression.Level of Evidence: II
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How to Cite
Layús, M., & Pasetto, P. (2020). Treatment of phalangeal and metacarpal fractures with intramedullary compression screws. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(4S), S2-S11. https://doi.org/10.15417/issn.1852-7434.2020.85.4S.1172
Section
Clinical Research
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References
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https://doi.org/10.1177/1753193416641319
5. Berg P, Mudgal C, Leibman M, Belsky M, Ruchelsman D. Quantitative 3-dimensional CT analyses of
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Surg Am 1989;14(3):474-81. https://doi.org/10.1016/s0363-5023(89)80006-1
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comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46.
https://doi.org/10.2106/JBJS.D.02060
9. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br
1984;66(1):114-23. PMID: 6693468
10. Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010;35(8):1260-3. https://doi.org/10.1016/j.jhsa.2010.04.032
11. Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014;39(12):2390-5.
https://doi.org/10.1016/j.jhsa.2014.08.016
12. Ozer K, Gillani S, Williams A, Peterson S, Morgan S. Comparison of intramedullary nailing versus plate-screw
fixation of extra-articular metacarpal fractures. J Hand Surg Am 2008;33(10):1724-31.
https://doi.org/10.1016/j.jhsa.2008.07.011
13. Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthop Relat Res 1996;327:38-46. https://doi.org/10.1097/00003086-199606000-00007
14. Fusetti C, Meyer H, Borisch N, Stern R, Della Santa D, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma 2002;52(3):535-9. https://doi.org/10.1097/00005373-200203000-00019
15. Hsu L, Schwartz E, Kalainov D, Chen F, Makowiec R. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am 2011;36(4):610-6. https://doi.org/10.1016/j.jhsa.2011.01.023
2. Del Piñal F, Moraleda E, Ruas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015;40:692-700. https://doi.org/10.1016/j.jhsa.2014.11.023
3. Meals C, Meals R. Hand fractures: A review of current treatment strategies. J Hand Surg Am 2013;38(5):1021-31.
https://doi.org/10.1016/j.jhsa.2013.02.017
4. Borbas P, Dreu M, Poggetti A, Calcagni M, Giesen T. Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study. J Hand Surg Eur 2016;41(7):683-7.
https://doi.org/10.1177/1753193416641319
5. Berg P, Mudgal C, Leibman M, Belsky M, Ruchelsman D. Quantitative 3-dimensional CT analyses of
intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am 2013;38(2):322-30.
https://doi.org/10.1016/j.jhsa.2012.09.029
6. American Society for Surgery of the Hand. The hand, examination and diagnosis. 3rd ed. New York: Churchill
Livingstone; 1990.
7. Pun W, Chow S, So Y, Luk K, Ip F, Chan K, et al. A prospective study on 284 digital fractures of the hand. J Hand
Surg Am 1989;14(3):474-81. https://doi.org/10.1016/s0363-5023(89)80006-1
8. Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH:
comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87(5):1038-46.
https://doi.org/10.2106/JBJS.D.02060
9. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br
1984;66(1):114-23. PMID: 6693468
10. Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010;35(8):1260-3. https://doi.org/10.1016/j.jhsa.2010.04.032
11. Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014;39(12):2390-5.
https://doi.org/10.1016/j.jhsa.2014.08.016
12. Ozer K, Gillani S, Williams A, Peterson S, Morgan S. Comparison of intramedullary nailing versus plate-screw
fixation of extra-articular metacarpal fractures. J Hand Surg Am 2008;33(10):1724-31.
https://doi.org/10.1016/j.jhsa.2008.07.011
13. Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthop Relat Res 1996;327:38-46. https://doi.org/10.1097/00003086-199606000-00007
14. Fusetti C, Meyer H, Borisch N, Stern R, Della Santa D, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma 2002;52(3):535-9. https://doi.org/10.1097/00005373-200203000-00019
15. Hsu L, Schwartz E, Kalainov D, Chen F, Makowiec R. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am 2011;36(4):610-6. https://doi.org/10.1016/j.jhsa.2011.01.023