Symptomatic Nonunion of a Distal Phalanx Fracture: Treatment With a Percutaneous Compression Screw

Meijs, Claartje M.E.M.; Verhofstad, Michael H J

doi:10.1016/j.jhsa.2009.02.022

Cited by 20 publications

(10 citation statements)

References 5 publications

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“…22 We do not think that it is necessary to use interfragmentary/lag screw fixation or to use a cancellous screw as reported by other authors. 19,21 The high union rates in our study support this opinion. In addition, lag screw requires overdrilling of the cortex and creates an additional step to the procedure.…”

Section: Management Of Dp Fractures Is Mostly Conservativesupporting

confidence: 79%

A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures

Hay

Tay

2015

The Journal of Hand Surgery

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Section: Management Of Dp Fractures Is Mostly Conservativesupporting

confidence: 79%

A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures

Hay

Tay

2015

The Journal of Hand Surgery

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“…The distal phalanx nonunion is rare, and specific guidelines for their treatment do not exist [5]. Although they reported good function results, it was necessary to remove screw for screw protrusion, screw senility, and fingertip tenderness [3].…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Intrafragmentary Compression Fixation with External Fixator (the Ichi-Fixator) Treatment of Distal Phalangeal Nonunion

Ichihara

Yamamoto

Hara

et al. 2020

Case Reports in Orthopedics

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The nonunion of distal phalangeal communized fracture is relatively rare in hand fractures. However, if it occurred, the surgical treatment is quite difficult because of small piece of fragmentations. We developed a new fixation method that involves the insertion of two wires and external wire compression fixation using a metal clamp. The aim of this technique was to increase the compression force between fragments and rigidity of conventional percutaneous Kirschner wire fixation. Here, we present a patient with the nonunion of distal phalangeal communized fracture who was satisfactorily treated with open reduction and percutaneous interfragmentary compression fixation with a linking external wire fixator (the Ichi-Fixator system). Such a treatment that enables compression fixation for communized distal phalangeal fracture of nonunion will clearly boost bone healing. Linked external wire-type compression fixator (the Ichi-Fixator system) enables enhanced security of fixation and facilitates the bone healing.

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“…5 In light of that report, it may not then be all that surprising that patients with headless screws buried beneath the presenting pinch surface of the distal tuft would report no significant pain with pinch loading. Fortunately, this did not prove to be the case.…”

Section: Complicationsmentioning

confidence: 91%

“…The smaller cancellous tuft fragments eventually develop a relatively stable fibrous union that is usually well tolerated by the patient. 5 Whether bone graft and an open approach are needed in most P3 nonunions remains unknown. The traditional descriptions for nonunions of long bones have included hypertrophic, oligotrophic, and atrophic types, each with recognizable features used to classify them.…”

Section: Historical Perspectivementioning

confidence: 99%

Variable Pitch Headless Compression Screw Treatment of Distal Phalangeal Nonunions

Henry

2010

Techniques in Hand &Amp; Upper Extremity Surgery

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Nonunions of the shaft of the distal phalanx, as opposed to the tuft, are usually symptomatic enough to warrant treatment. One method that has proven successful while minimizing complications is compression fixation using variable pitch headless screws inserted percutaneously. Eighteen patients (15 males, 3 females) with a mean age of 48 years were so treated under digital block anesthesia. Seven of 18 (39%) patients were smokers. All initial injuries were crush trauma to the distal phalanx with 10/18 (56%) initially open fractures. Treatment was to 3 thumbs, 6 index fingers, 6 long, 2 ring, and 1 small. Fixation was with micro-sized variable pitch cannulated headless screws except 1 case that used 2 noncannulated threaded taper pins to compress a 3 fragment nonunion. Surgery to treat nonunion occurred at a mean of 13 weeks after the initial injury. Time to union was determined by combined clinical and radiographic assessment. The clinical criterion for union was the absence of pain at the nonunion site with application of maximum pinch pressure to the ipsilateral thumb or finger. The radiographic criteria for union was bridging trabeculae seen on 2 or more cortices and the absence of any signs of hardware loosening, using standard posteroanterior and lateral projections. All 18 patients went on to achieve union at a mean of 9 (±2.8) weeks after surgery. Complications specifically sought out but not identified were infection, loss of reduction, further comminution, hardware loosening, secondary surgery, nail deformity, and continued pain precluding successful pinch.

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Symptomatic Nonunion of a Distal Phalanx Fracture: Treatment With a Percutaneous Compression Screw

Cited by 20 publications

References 5 publications

A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures

A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures

Open Reduction and Intrafragmentary Compression Fixation with External Fixator (the Ichi-Fixator) Treatment of Distal Phalangeal Nonunion

Variable Pitch Headless Compression Screw Treatment of Distal Phalangeal Nonunions

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