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Review
. 2022 Dec;10(12):1004-1012.
doi: 10.22038/ABJS.2022.64506.3102.

Fixation of Hand Fractures with Intramedullary Headless Compression Screws

Nicolas M Dohse  1 , Christopher M Jones  2 , Asif M Ilyas  2
Affiliations
Review

Fixation of Hand Fractures with Intramedullary Headless Compression Screws

Nicolas M Dohse et al. Arch Bone Jt Surg. 2022 Dec.

Abstract

Metacarpal and phalangeal fractures remain among the most frequently encountered orthopedic injuries, accounting for 10% of all fractures. For operative fractures, there is an array of treatment options with percutaneous kirschner wire stabilization and screw and plate fixation strategies predominating. Recently, a new fixation method was introduced, intramedullary (IM) fixation with headless screws, which has advantages of a percutaneous technique and buried hardware. The purpose of this review is to highlight the indications and surgical techniques of IM screw fixation of metacarpal and phalangeal fractures. Although more research is needed, IM fixation represents a potentially reliable alternative to Kirschner-wire and plate fixation.

Keywords: Indications; Intramedullary compression; Metacarpal fracture; Phalanx fracture; Technique.

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Figures

Figure 1
Figure 1
Top: Example of an intramedullary screw under 3.0mm in diameter that does not exceed 50 or 60mm in length due to biomechanical weakness beyond those lengths. Bottom: Intramedullary screws without compression
Figure 2
Figure 2
Top left: AP radiograph of pin placement using retrograde approach to metacarpal. Top right: AP radiograph showing introduction of screw using retrograde approach to metacarpal
Figure 3
Figure 3
AP and lateral radiographs showing introduction of guide wire using retrograde approach to proximal phalanx
Figure 4.
Figure 4.
Left: AP image showing measurement tool used to determine screw length. Right: AP image showing introduction of screw using retrograde approach to proximal phalanx
Figure 5
Figure 5
AP and lateral view of final screw placement for retrograde approach to proximal phalanx
Figure 6
Figure 6
AP and lateral image of guide wire placement using the retrograde approach to the middle phalanx
Figure 7
Figure 7
AP and lateral views of screw insertion using retrograde approach to the middle phalanx
Figure 8
Figure 8
AP and lateral view of final screw placement after retrograde approach to middle phalanx
Figure 9
Figure 9
AP and lateral view of guide wire insertion using antegrade approach to proximal phalanx
Figure 10
Figure 10
AP view showing introduction of screw to proximal phalanx using antegrade approach
Figure 11
Figure 11
AP and lateral view of final screw placement using antegrade approach to proximal phalanx
Figure 12.
Figure 12.
Example of bent screw due to biomechanical weakness
See this image and copyright information in PMC

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