Minimally Invasive Fixation of Fractures of the Phalanges and Metacarpals With Intramedullary Cannulated Headless Compression Screws

Piñal, Francisco del; Moraleda, Eduardo; Rúas, Jaime S.; Piero, Guillermo H. de; Cerezal, Luís

doi:10.1016/j.jhsa.2014.11.023

Cited by 169 publications

(219 citation statements)

References 21 publications

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“…5 Periarticular fractures of the upper extremity can be reliably treated with buried intra-articular fixation. [6][7][8][9][10][11][12][13][14] This series presents the clinical results of a relatively new technique of fixation for metacarpal fractures using retrograde intramedullary headless screws (IMHS) that allows early mobilization with minimal complications.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

2016

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BackgroundThere is a lack of consensus on optimal treatment methods for operative fixation of metacarpal fractures. 1 Classic treatment options include plate and screw fixation or percutaneous fixation with Kirschner wires (K-wires). 1,2 For subcapital fractures or those fractures involving the metacarpal neck, the lack of distal purchase can preclude plate and screw fixation. Short oblique, transverse, comminuted, or multiple metacarpal shaft fractures typically require more rigid fixation with lag screws or plate and screw constructions. Plate and screw fixation can be associated with considerable metacarpophalangeal stiffness, necessitating secondary implant removal and joint release. While K-wire fixation for metacarpal fractures often results in bony union, it necessitates a period of immobilization and has a complication rate up to 16%. 3,4 Bouquet pinning with intramedullary wires placed in an antegrade manner can often be satisfactory but requires immobilization, future implant removal, and may not always offer secure fixation or rotational control. 5 Periarticular fractures of the upper extremity can be reliably treated with buried intra-articular fixation. 6-14 This series presents the clinical results of a relatively new technique of fixation for metacarpal fractures using retrograde intramedullary headless screws (IMHS) that allows early mobilization with minimal complications. Keywords► metacarpal fracture ► intramedullary fixation ► headless compression screw ► minimally invasive AbstractIntroduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.

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Section: Introductionmentioning

confidence: 99%

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

2016

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“…Our clinical and functional results are similar to those found in several series published in recent years, showing satisfactory results with this type of treatment. [5][6][7]18,19 The surgical treatment of the metacarpal has been very effective, with results close to 100% mobility.…”

Section: Discussionmentioning

confidence: 99%

“…The patients resumed their normal activity with an average time of 5 weeks (3-32 weeks) (►Figs. 3,4,5).…”

Section: Metacarpalsmentioning

confidence: 99%

“…Internal fixation involves soft tissue dissection, which consequently causes scar tissue to appear on the osteosynthesis plate and on the focus of the fracture, facilitating the tenodesis effect. 4 To achieve adequate fixation of the fracture, and following the experience of other authors [5][6][7] we use retrograde intramedullary cannulated screws in the treatment of fractures of the metacarpals and of the proximal and middle phalanxes. This technique provides rigid fixation and compression of the focus, with minimal soft tissue involvement.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Osteosynthesis with Headless Cannulated Screws in the Treatment of Metacarpal and Proximal and Middle Phalanxes Fractures of the Hand

Casal

Vegas

Díez

et al. 2018

Rev Iberoam Cir Mano

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Introduction There is a high incidence of hand fractures, and a high percentage of them require surgical treatment. The functional result depends, to a large extent, on the technique used. The use of retrograde intramedullary screws allows for early mobilization and minimal dissection of soft tissues. The objective of the present study is to analyze the clinical results and complications with this type of osteosynthesis. Methods A total of 96 fractures in 81 patients were analyzed. There were 62 metacarpal fractures, 60% of which involved the 5th finger, 29% involved the 4th, 5% involved the 3rd, and 6% involved the 2nd finger. There were 34 fractures of the phalanxes, 27 of which (79.5%) involved the proximal phalanx, and 20.5% involved the middle phalanx. The range of active mobility, the time spent at work, and intraoperative complications were assessed. Results The average active mobility obtained was 260° (230–270°). Patients resumed their normal activity within an average time of 5 weeks (between 3 and 32 weeks). There was a 6% rate of intraoperative complications and a 13% rate of postoperative complications in the metacarpals, and an 8% rate of intraoperative complications and 11% of postoperative complications in the phalanxes. Conclusion The use of cannulated screws is a safe and effective option for the treatment of different types of fractures, obtaining a good range of mobility, early reintegration, and with an acceptable number of complications.

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“…7 La utilización de tornillos canulados sin cabeza introducidos de manera retrógrada, está indicado en determinados tipos de fracturas de metacarpianos y falanges y presentan ventajas en relación a los otros tipos de osteosíntesis. [8][9][10][11][12][13] Los tornillos son introducidos percutáneamente, permitiéndonos una fijación estable con una cirugía mínimamente invasiva. Ellos se introducen a través de una superficie articular y debido a su ausencia de cabeza, permiten que sean enterrados en el hueso subcondral sin interferir en el movimiento articular.…”

Section: Introductionunclassified

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

Vegas

Díez

Núñez

et al. 2017

Rev Iberoam Cir Mano

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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.

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Minimally Invasive Fixation of Fractures of the Phalanges and Metacarpals With Intramedullary Cannulated Headless Compression Screws

Cited by 169 publications

References 21 publications

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

Percutaneous Osteosynthesis with Headless Cannulated Screws in the Treatment of Metacarpal and Proximal and Middle Phalanxes Fractures of the Hand

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

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