Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

Abstract

Osteosynthesis of metacarpal and phalangeal fractures with headless compression screws leads to a defect in the articular surface and possibly damage to the extensor tendons. This study aimed to quantify the articular surface defect and extensor tendon injuries after implant placement in cadaveric hands. Defect size was assessed with computed tomography. Extensor tendon injuries were assessed by direct visualization and measurement after dissection. In the middle phalanx, the defect size in relation to the joint surface was significantly smaller after anterograde screw placement when compared with retrograde placement. Also, a mini-open approach was found to cause significantly less tendon injury than a percutaneous approach, but there was no difference in tendon damage between retrograde and antegrade screw insertion into the middle phalanx.

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

“…Theoretically, this could jeopardize the extensor central slip at the proximal interphalangeal joint (Nucci et al., 2018). However, this is not supported by clinical and experimental data, as suggested by the absence of secondary boutonnière deformity in our series and by the results of the cadaveric study of Urbanschitz et al. (2020).…”

“…Obviously, this technique implies some damage to the articular cartilage from passage of the screw. Some cadaveric studies have quantified cartilage disruption relative to the entire articular surface, but the clinical relevance of these findings is still unknown (Borbas et al., 2016; Urbanschitz et al., 2020). In our study no radiographical signs of articular degeneration were found at final follow-up.…”

“…In proximal phalangeal fractures, we used an anterograde introduction associated with negligible articular surface violation (Borbas et al., 2016; Urbanschitz et al., 2020). The anterograde fixation was used with an intra-articular technique, introducing the guidewire through the metacarpophalangeal joint into the base of the proximal phalanx.…”

Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls

“…Urbanschitz et al demonstrated an avoidance of extensor tendon injury with open technique when compared with percutaneous in both metacarpal and phalangeal fractures. 29 Upon dissection analysis of tendon, there was significantly less damage in the open technique ( P < 0.001) due to direct tendon visualization and protection. The authors also found a higher incidence of tendon injury in fixating phalanges compared with metacarpal regardless of anterograde or retrograde percutaneous technique.…”

Intra-Medullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls, and Pitfalls

“…Considerations can be given to a true percutaneous technique when taking into consideration the potential for injury to the extensor mechanism. Urbanschitz, et al demonstrated an avoidance of extensor tendon injury with open technique when compared to percutaneous in both metacarpal and phalangeal fractures [28]. Upon dissection analysis of tendon, there was significant less damage in open technique (p < 0.001) due to direct tendon visualization and protection.…”