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Phalangeal fracture fixation through the joint; quantification of articular involvement
Jordan Pearce, MD¹; Allicia Imada, MD¹; Julie Mekhail, MS²; Nikalus Skipp, BS¹; Caroline Ardizzone, MD¹; Ann L Wells, PhD³; Deana M. Mercer, MD^4
1University of New Mexico, Albuquerque, NM; ²Chicago Medical School, North Chicago, IL; ³University of New Mexico School of Medicine, Albuquerque, NM; ⁴The University of New Mexico, Albuquerque, NM

Introduction

Phalanx fractures have traditionally been treated with K wires. This has transitioned to intramedullary 2.5/3.5 mm screw fixation for immediate motion and elimination of tendon/ligament binding. There is some hesitation in utilizing this method due to articular cartilage penetration required to employ this technique. We hypothesize that the percentage of articular cartilage involvement in the fixation of phalanx fractures through the articular surface will be a fraction of the total surface area.

Materials and Methods

14 fresh-frozen cadaver hands were utilized. We placed screws antegrade and retrograde centrally into the proximal phalanx (PP) and middle phalanx (MP) through the articular surface under fluoroscopic guidance. The articular surface was photographed, and Image J software was used for measurement by 3 reviewers who performed the measurement 3 times.

Results

2.5mm screw:

Index and middle finger proximal phalanx retrograde:

For 2.5 mm retrograde screw placement in the index and middle finger respectively, the average total area of articular surface involvement was 119.9 mm2 and 129.8 mm2 and the percentage involvement was 3.8% and 4.3%.

Index and middle finger middle phalanx and distal phalanx retrograde through the distal interphalangeal joint:

For 2.5mm screw retrograde placement in the index and middle finger respectively, the average total area of articular surface involvement was 87.2mm2 and 94.1mm2 and the percentage involvement was 6.8% and 4.4% .

The DP total articular surface area for the index and middle finger respectively measured 47.9mm2 and 50.1mm2 and percent involvement was 11.0% and 10.6%.

Ring and small finger middle phalanx retrograde:

Ring finger percentage involvement of 6.9%. Small finger percentage involvement of 8.5%.

Ring and small finger proximal phalanx antegrade:

Ring and small finger percentage articular involvement respectively was 4.4% and 6.2%.

3.5mm screw:

For the Index, middle, ring and small finger PP respectively, the percent articular involvement was 5.9%, 5.9%, 6.0%. 7.1%.

Inter- and intra-rater reliability was calculated using Intraclass correlation coefficients (ICC). 0.76 and 0.91 Good

Conclusion

Screw placement through the articular surface of the proximal and middle phalanx involves less than 10% of the articular surface in all fingers and less than 12% in the distal phalanx. It may be beneficial, in appropriate clinical situations, to fix phalanx fractures intramedullary as it may allow immediate motion with no soft tissue binding limitations.

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