Minimal invasive technique in fixation of fracture phalanx by Intramedullary Herbert screw

Abstract

Hand fractures are very common fractures in orthopedics injuries, and even one of the most common fractures in the upper extremity fractures.there are many different methods of fixation that can be used in the treatment, .Among these methods is fixation of fractures with a Herbert screw, which are suitable for transverse fractures and oblique fractures, which is the subject of this study This study aimed to analyze the clinical and functional results from patients with a diagnosis of unstable reducible extra-articular fracturing of the phalanx with displacement, who underwent surgical treatment by means of a minimally invasive percutaneous osteosynthesis technique using an Herbert screw in order to avoid interfering with the extensor tendon of this finger. Twenty patients, 15 males and 5 females with a mean age of was 36.25 years, (range, 23-57 years). Direct trauma was predominant cause of injury accounting 65 % followed by RTA and trivial trauma 35 %. Sixteen patients had transverse fracture (80%) and four had oblique fracture (20%). the small finger was the most commonly affected digit (12 patients) and other finger (4 middle, 3 index and 1 ring). the mean radiological union time was 7.7 weeks (range 6-10 weeks). Final QuickDASH score was 4.5.The mean TAF was 249° (range, 245°-270°).The mean TAM was 246.25° (rang, 235°-270°).All the patients follow-up visits were scheduled in the outpatient clinic at 2 weeks, 4 weeks, 6 weeks, 8weeks, 3 months and 6 months .Herbert screw intramedullary fixation is an effective technique for the treatment of transverse and short oblique proximal and middle phalangeal fractures. We found that it can be applied successfully even in peri-articular fractures of the proximal third of the phalanx, and it a safe method for almost of these fracture types giving a higher ROM and less complication.