Variable Pitch Headless Compression Screw Treatment of Distal Phalangeal Nonunions

Abstract

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.

Dimensional Analysis of the Distal Phalanx with Consideration of Distal Interphalangeal Joint Arthrodesis Using a Headless Compression Screw

“…Arthrodesis of the DIP joint is the gold standard of definitive treatment, and a variety of techniques have been described [1-4, 6-10, 12, 14]. Complication rates of DIP joint fusion have been reported from 0-22 % [2,4,5,9].…”

“…Rheumatoid arthritis, degenerative arthritis, post-traumatic arthritis, and nonunion are common causes. Arthrodesis of the DIP joint is the gold standard of definitive treatment, and a variety of techniques have been described [1–4, 6–10, 12, 14]. Complication rates of DIP joint fusion have been reported from 0–22 % [2, 4, 5, 9].…”

Intramedullary Headless Screw Fixation for Metacarpal Fractures

“…14 Headless compression screws have been used successfully for a variety of hand and wrist fractures. [15][16][17] Moreover, IM fixation has become the standard of care for the treatment of long bones of the lower extremity, owing to its excellent biomechanical strength and preservation of soft tissue. In the setting of extra-articular metacarpal fractures, IM implants have the potential to offer a less invasive method of fixation without sacrificing stability.…”

An Evidence-Based Guide for Managing Phalangeal Fractures

“…These include percutaneous variablepitch compression headless screws, open reduction and interfragmentary screw fixation, and bone grafts. [9][10][11][12][13] Chim et al evaluated 14 patients with distal phalangeal shaft or neck fractures complicated by symptomatic nonunion that were treated by open reduction and interfragmentary screw fixation. 11 At a mean 4.2 months after surgery, all fractures were united and all patients regained normal function of the finger.…”