Subscribe to RSS
Use of Intramedullary Cannulated Headless Screws in the Treatment of Hand Fractures - An Anatomical Study on Long FingersArticle in several languages: English | español
12 July 2017
25 September 2017
22 November 2017 (online)
Objective To quantify the cartilaginous and tendinous lesions produced upon percutaneous introduction of intramedullary cannulated screws as osteosynthesis material in metacarpal and phalangeal fractures.
Materials and Methods Seven anatomical models and one non-replanted hand were used. The measurements of 30 metacarpals and proximal and middle phalanges were taken. Cannulated screws with complete and partial threads were placed percutaneously through the metacarpal head and the proximal and middle phalanges, reproducing the actions performed in the clinic. The following measurements were performed: A) Percentage of the damaged cartilaginous area and its location. B) Damage to the extensor apparatus and its distance to the bone insertion point. C) Bone marrow size.
Results (A) The percentages of the damaged areas in the metacarpals, proximal and middle phalanges were 5.7%, 13.35% and 9.62%, respectively. (B) The damage to the extensor apparatus was less than 3 mm with a 4-mm distance to the bone insertion point and (C) We have obtained the measurements of the intramedullary bone and from them, we calculated the width of the most appropriate screw.
Conclusion In conclusion, the use of retrograde and percutaneous cannulated screws is a reliable technique with regard to the associated morbidity, and we present an approximation regarding the most appropriate screw for each location.
- 1 Cheah AE, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations. J Hand Surg Am 2016; 41 (06) 712-722
- 2 Winter M, Balaguer T, Bessière C, Carles M, Lebreton E. Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur Vol 2007; 32 (06) 709-713
- 3 Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res 2015; 473 (05) 1747-1754
- 4 Hornbach EE, Cohen MS. Closed reduction and percutaneous pinning of fractures of the proximal phalanx. J Hand Surg [Br] 2001; 26 (01) 45-49 (British And European Volume)
- 5 Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg Am 1984; 9 (05) 725-729
- 6 Elmaraghy MW, Elmaraghy AW, Richards RS, Chinchalkar SJ, Turner R, Roth JH. Transmetacarpal intramedullary K-wire fixation of proximal phalangeal fractures. Ann Plast Surg 1998; 41 (02) 125-130
- 7 Balaram AK, Bednar MS. Complications after the fractures of metacarpal and phalanges. Hand Clin 2010; 26 (02) 169-177
- 8 Aita MA, Mos PA, de Paula Cardoso Marques Leite G, Alves RS, Credídio MV, da Costa EF. Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw. Rev Bras Ortop 2015; 51 (01) 16-23
- 9 Giesen T, Gazzola R, Poggetti A, Giovanoli P, Calcagni M. Intramedullary headless screw fixation for fractures of the proximal and middle phalanges in the digits of the hand: a review of 31 consecutive fractures. J Hand Surg Eur Vol 2016; 41 (07) 688-694
- 10 Doarn MC, Nydick JA, Williams BD, Garcia MJ. Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results. Hand (NY) 2015; 10 (02) 314-318
- 11 del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015; 40 (04) 692-700
- 12 Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014; 39 (12) 2390-2395
- 13 Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010; 35 (08) 1260-1263
- 14 Lazar G, Schulter-Ellis FP. Intramedullary structure of human metacarpals. J Hand Surg Am 1980; 5 (05) 477-481
- 15 ten Berg PW, Mudgal CS, Leibman MI, Belsky MR, Ruchelsman DE. Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am 2013; 38 (02) 322-330
- 16 Schulter-Ellis FP, Lazar GT. Internal Morphology Of Human Phalanges. J Hand Surg Am 1984; 9 (04) 477-481
- 17 Borbas P, Dreu M, Poggetti A, Calcagni M, Giesen T. Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study. J Hand Surg Eur Vol 2016; 41 (07) 683-687
- 18 Shimizu T, Omokawa S, Akahane M. , et al. Predictors of the postoperative range of finger motion for comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate. Injury 2012; 43 (06) 940-945
- 19 Pun WK, Chow SP, So YC. , et al. Unstable phalangeal fractures: treatment by A.O. screw and plate fixation. J Hand Surg Am 1991; 16 (01) 113-117
- 20 Faruqui S, Stern PJ, Kiefhaber TR. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am 2012; 37 (07) 1342-1348
- 21 Fujitani R, Omokawa S, Shigematsu K, Tanaka Y. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci 2012; 17 (04) 450-456
- 22 Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?. Orthop Traumatol Surg Res 2010; 96 (05) 506-512
- 23 Yammine K, Harvey A. Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2014; 24 (03) 273-278