Percutaneous Cannulated Compression Screw Osteosynthesis in Phalanx Fractures: The Surgical Technique, the Indications, and the Results

Abstract

Objective: Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. Methods: We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Results: Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. Conclusions: The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures.

Keywords: cannulated screw; compression screw; hand fracture; percutaneous screw fixation; phalanx fracture.

Figure 1

Operative technique. An oblique fracture of the proximal phalanx (a, b). After reposition and retention of the fracture with a reduction clamp (c, d), a 0.7-mm K-wire is inserted and secured into the opposite cortex (e-g). Defining the length and punching of the first corticalis is possible with the same device (h). The screw is then inserted over the K-wire (i-l). Postoperative control after inserting 2 screws in the same way (m, n).

Figure 2

Four different cases (row a-d) with pre- and postoperative radiographs. (a) Intra-articular PIP joint fracture of the middle phalanx with 2 screws. (b) Typical extra-articular displaced oblique fracture treated with 2 screws. (c) Multiple fragments in the proximal phalanx treated with 3 screws, which is certainly a limitation for this type of osteosynthesis. (d) Mulifragment proximal phalanx fracture treated with 3 screws.

Figure 3

Presentation of a case. A 43-year-old patient undergoing a dislocated spiral fracture of the proximal phalanx of digiti minimi (a, b). The postoperative radiographs after the screw osteosynthesis (c, d). Note the missing head of 1 screw (c). Two weeks after the surgery, a secondary displacement of the fracture appeared (e, f) and was corrected by a new K-wire osteosynthesis (g, h). The broken screwhead (i) and the bent 0.7-mm K-wire used for the screw osteosynthesis (j).