Article
Intramedullary cannulated headless compression screws osteosynthesis for metacarpal and phalangeal fractures
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Authors
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Alessandro Fagetti
- Ospedale Circolo Fondazione Macchi Varese, Varese, Italy
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Francesca Fissore
- Insubria University - Varese-Como, Varese, Italy
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Paolo Borelli
- Casa di Cura San Camillo, Brescia, Italy
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Denise Girotto
- Insubria University - Varese-Como, Varese, Italy
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Mario Cherubino
- Ospedale Circolo Fondazione Macchi Varese, Varese, Italy
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Michele Francesco Surace
- Ospedale Circolo Fondazione Macchi Varese, Varese, Italy
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Intramedullary fixation of metacarpal and phalangeal fractures using cannulated headless screws is an effective technique with several theoretical advantages, among which minimal local invasiveness and early mobilization. The aim of our study is to evaluate the functional results and subjective evaluation.
Methods: 29 patients with a total of 33 fractures (26 metacarpal and 7 phalangeal) were surgical treated by the same surgeon with intramedullary cannulated headless screws.
3 patients had multiple fracture and they were all treated with this technique and in 4 cases there were severe soft tissue injury associated. Five were open fractures.
Patients were followed prospectively until bone radiographical healing and a last evaluation was performed with a minimum 6 months follow-up.
Functional results were evaluated in terms of active range of motion, grip force and pinch key, MHQ (Michigan Hand outcome Questionaire) and VAS (Visual Analogc Scale).
Results and Conclusions: At the latest follow-up (average 14 months, range 6-28) the mean total active motion was 239° (range 105°-280°), 250° (150-280) for metacarpals and 197° (105-280) for phalanges. Even if the technique requires a violation of the extensor tendon, the mean extension LAG at the MF was 1° and 0.7° at the PIP (excluding patients with concomitant tendon lesions).
Patients recovered grip strength that was not significantly different from the contralateral limb. The average MHQ evaluation of patients with no associated lesions was 98% (compared to 75% of patients with associated soft tissue traumas).
Patients with transverse and short oblique fractures obtained objective and subjective better results than patients with comminuted fractures.
There were no cases of secondary displacement, malunion or non-union, rotational defects, infections or CRPS. Complications in terms of decreased range of motion and functional poor results were observed only in 3 of the 4 patients with associated soft tissue trauma (tenolysis is already planned for two of them).
Despite intramedullary devices for treatment of metacarpal and phalangeal fractures has been known for a long time, the use of intramedullary compression cannulated headless screws has recently been increased. In our experience and according to literature, this technique leads to better results in transverse and short oblique fractures and allow early mobilization and faster coming back to activities.
