Limited Incision Open Reduction and Internal Fixation of Proximal Phalanx Fractures with Headless Screws
Jason West, BA, UNLV, Las Vegas, NV, Robert Gray, MD, Northshore, Glenview, IL, Deana Mercer, MD, Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM and Nathan Hoekzema, MD, University of california fresno, fresno, CA
Title:
Limited Incision Open Reduction and Internal Fixation of Proximal Phalanx Fractures with One or Two Headless Screws
Introduction:
Proximal phalanx fractures are among the most common in the human skeleton, accounting for 23% of below-elbow fractures.1 Even small degrees of malrotation or extension at the fracture site can lead to significant impairments in motion and function. Numerous methods for treating displaced proximal phalanx fractures have been in place. Percutaneous pinning, open reduction and internal fixation with plates and screws, splint immobilization and external fixation all are used. Frequent problems include stiffness, tendon irritation, Pin site complications, and malunion. We present the technique of limited incision open reduction and internal fixation of proximal phalanx fractures with two headless screws and early follow up for a case series of limited incision open reduction and internal fixation with headless compression screws.
Technique:
Under local anesthesia, closed reduction of the fracture is performed under fluoroscopic guidance. Two small stab incisions are made on either side of the metacarpal head at the level of the collateral recess through skin only. Guidewires are inserted to the base of the proximal phalanx at the 2:30 and 9:30 positions and drilled antegrade in a converging but not crossing fashion.
Orthogonal fluoroscopic imaging is used to verify adequate fracture reduction and wire placement. Using a hand driver rather than a power driver, the wires are overdrilled, countersunk, and measured. Appropriate length screws are placed. Though ideal, it is not necessary for the screws to be of equal length as long as they both have adequate purchase proximal and distal to the fracture line.
The patient is immobilized for 3 days in a soft dressing and then early active Occupational Therapy performed.
Methodology:
Twelve patients with 16 fractures were treated with the above technique. Four fractures ad one screw. Twelve had two screws. Clinical photographs and video and x-rays were reviewed. Total active motion average, time to union average, visual analog scale average, and percentage of patients were satisfied with the results was calculated from the data.
Results:
Total active motion average: 240 degrees
Average time to union average: 8 weeks
Visual analog scale average: 0.8
Percentage of patients were satisfied with the results: 91%
Conclusion:
Limited incision ORIF with 2 headless screws is a viable option for proximal phalanx fracture fixation. It offers early rehabilitation and limits hardware morbidity and tendon irritation.
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