Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up

Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review

PURPOSE

There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures.

METHODS

A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data.

RESULTS

Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery.

CONCLUSIONS

Complications following IMS fixation of metacarpal fractures are relatively uncommon.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Complications of osteosynthesis for long-finger metacarpal and phalanx fracture

Fractures of the metacarpals and phalanges represent a significant proportion of hand fractures. Although non-operative treatment is generally effective, some fractures require surgery. Historically, osteosynthesis using K-wires was widely used, but screw plates and then cannulated intramedullary screws have emerged as therapeutic alternatives. We assessed the complications associated with the different osteosynthesis techniques: stiffness, infection, bone consolidation and hardware-related problems. Each osteosynthesis technique has advantages and disadvantages, and choice depends on several factors. An individualized approach according to patient and fracture is essential to optimize clinical results.

Intramedullary headless compression screw fixation of the middle phalanx: tips, tricks, and pitfalls

This report emphasizes careful consideration of surgical technique for intramedullary screw fixation in middle phalanx fractures. Highlighting pitfalls, particularly with K-wire placement, it suggests the antegrade trans-articular approach as superior, urging further research for improved patient outcomes.

Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures

PURPOSE

This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures.

METHODS

A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature.

RESULTS

Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort.

CONCLUSION

Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.

Cost Analysis of Intramedullary Screw versus Plate Osteosynthesis for Phalangeal and Metacarpal Fractures: An Observational Study

Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).

The Addition of a Temporary Intramedullary K-wire to Facilitate Plating for Metacarpal Fractures

Open reduction internal fixation with plate fixation is commonly used in treating metacarpal fractures to facilitate early rehabilitation. However, it is sometimes challenging to maintain a satisfactory 3-dimensional alignment during the plating process. We present a method using a temporary centrally placed intramedullary k-wire to maintain a fundamental stability for reduction of metacarpal fractures. This method facilitates the plating process and simplifies the open reduction internal fixation of the metacarpal fractures.

Expanding the applications of intramedullary cannulated screw fixation in the hand

OBJECTIVES

Intramedullary cannulated headless compression screw fixation (ICHCS) is gaining popularity for managing metacarpal and phalangeal fractures, but is still relatively new to the surgical landscape. We aim to further illustrate its utility and versatility by presenting the outcomes of such fractures treated with ICHCS at two tertiary plastic surgery centres. Primary objectives were to assess functional range of motion, patient-reported outcomes, and complication rates.

MATERIALS AND METHODS

All patients with metacarpal or phalangeal fractures treated with ICHCS (n = 49) between September 2018 and December 2020 were retrospectively reviewed. Outcomes were active ranges of motion (TAM), QuickDASH scores (obtained via telephone), and complication rates. Two-tailed Student's t-tests evaluated differences between centres.

RESULTS

TAMs were available for 59% (n = 34/58) of fractures; 70.7% were metacarpal and 29.3% were phalangeal. The mean cohort metacarpal TAMs and phalangeal TAMs were 237.7° and 234.5°, respectively. QuickDASH scores were available for 69% (n = 34/49) of patients. The mean cohort score for metacarpal fractures was 8.23, and 5.13 for phalangeal. Differences between the two centres were statistically significant (p < 0.05). Two complications occurred, giving an overall complication rate of 3.45%.

CONCLUSION

Our results corroborate previous reports on ICHCS, further demonstrating its versatility and capacity to provide excellent outcomes. More prospective, comparative studies are needed to fully determine the suitability of ICHCS.

[Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]

INTRODUCTION

Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique.

MATERIAL AND METHOD

We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage.

RESULTS

At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily.

CONCLUSION

This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.

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

INTRODUCTION AND IMPORTANCE

The rotational deformity is formed due to the instability of the fixation device used before in a spiral or oblique fracture pattern, and will create uncomfortable sensation also disturb daily activities. This condition usually treated with several methods of osteotomies and implants, that involving large wound and longer period of healing.

CASE PRESENTATION

A 27-year-old male with chief complaint of discomfort sensation when the ring finger flexed and it was disturbing the daily activities. Two years ago, the patient was diagnosed with minimally displace closed fracture of the ring finger phalanx media and treated with buddy tapping for six months and become a malunion until now. Multiple drill hole osteotomy were made to correct the rotational position and fixed with Herbert screws. Three months follow up, the wound healed nicely and able to perform his daily activity.

CLINICAL DISCUSSION

Malunion that was formed from previous inadequate treatment could make uncomfortable sensation and disturbing daily activities usually treated with large osteotomies. Multiple drill hole (MDH) usage in combination with the Herbert screw to fix the new fracture line had several advantages compared to standard methods that were previously performed.

CONCLUSION

The combination of multiple drill hole and Herbert screws could be an alternative procedure with minimal surgical wounds. Without implant removal in the future, the patient can proceed to rehabilitation and return to his daily activities.

Headless Compression Screw for Metacarpal Nonunion: Description of a New Technique and Report of 4 Cases

Nonunion is a rare complication of metacarpal fractures and is usually associated with compound, open fractures with tissue loss and infection, or after failed surgical treatment. Repair by rigid osteosynthesis with plate and screws combined with autologous bone grafting has always been the treatment of choice for most patients. Such method allows early motion, although it has been proven that the presence of hardware may cause local soft tissue irritation. Often, hardware removal and tendon releases are necessary. We describe an original technique with a fixation method for the treatment of metacarpal nonunions, considering the excellent results attained with an intramedullary, headless screw for metacarpal fracture fixation. We report a series of three cases that evolved to bone healing with excellent clinical, functional, and radiographic outcomes.

Effect of Joint Use of External Minifixator and Titanium Lockplate on Total Active Motion Range and Hand Function Recovery in Comminuted Metacarpal and Phalanx Fracture Patients

Objective

To explore the effect of joint use of external minifixator and titanium lockplate on total active motion (TAM) range and hand function recovery in comminuted metacarpal and phalanx fracture patients.

Methods

The medical data of 70 patients with comminuted metacarpal and phalanx fracture treated in our hospital from June 2017 to June 2020 were screened for the retrospective study, and the patients were divided into the control group (Kirschner wire internal fixation) and the study group (an external minifixator with titanium lockplate) according to the treatment modalities, with 35 cases each. After treatment, the clinical efficacy of patients was compared between the two groups.

Results

No between-group differences in patients' general data were observed (P > 0.05); the time for hospital stay and fracture healing was obviously shorter in the study group than that in the control group (P < 0.05); after treatment, the study group obtained significantly higher TAM range good rate (P < 0.05), significantly higher Carroll hand function test pass rate (P < 0.05), and obviously better grip strength of both hands and score on digital opposition of thumb than those in the control group (P < 0.05); and after surgery, the study group had significantly lower incidence rates of complications such as infection, local inflammation, displacement of bone, and adhesion of tendon that those in the control group (P < 0.05).

Conclusion

Joint use of an external minifixator and titanium lockplate can effectively promote the TAM range and accelerate hand function recovery for comminuted metacarpal and phalanx fracture patients and is conducive to reducing the incidence of postoperative complications, which is safe and has significant efficacy.

Extra-articular mini-open proximal phalanx osteotomy with retrograde intramedullary headless screw under WALANT - Surgical technical

We report on the surgical technique for mini-open derotation osteotomy using retrograde osteosynthesis by headless compression screw under WALANT anesthesia (video attached). Preoperative CT showed the feasibility of this technique, with a 2.2 mm headless compression screw. The mechanical stability of the resulting constructs combined with intraoperative active motion testing under WALANT authorized immediate rehabilitation without immobilization, thus preventing stiffness. Joint range of motion recovered by day 4 and bone consolidation was achieved at 30 days.

Intramedullary screw fixation of metacarpal and phalangeal fractures - A systematic review of 837 patients

Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique is currently the subject of controversy among hand surgeons. The aim of this systematic review was to gain insight on radiological, functional and patient-rated outcomes reported in literature. A comprehensive literature search of PubMed, Embase, CENTRAL and CINAHL databases was conducted on March 1st, 2021. All studies reporting on fracture union, complications, and functional and patient-rated outcome in IMS fixation of metacarpal and/or phalangeal fractures were selected. Two prospective and 16 retrospective cohort studies were included, encompassing a total of 837 patients with 958 fractures (693 metacarpal, 222 proximal phalangeal and 43 middle phalangeal). Mean surgery duration was 26.4 min (range 5-60 min). Union was ultimately achieved in all fractures in a mean of 5.7 weeks (range 2-12 weeks). The procedure-related complication rate was 3.2%. The most frequently reported complication was limitation of joint motion, occurring in 2.0% of cases. Incidence of other complications, including loss of reduction, infection and screw protrusion did not exceed 1%. Overall mean total active motion averaged 243° and grip strength reached 97.5% of the contralateral side. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 3.7 points. Duration of sick leave was 7.3 weeks. According to the findings of this systematic review, IMS fixation is a time-saving and safe minimally invasive solution for both metacarpal and phalangeal fractures, with a low rate of complications and promising functional and patient-rated results.