Functional and Radiological Results of Phalanx Fractures Fixation with Intramedullary Cannulated Headless Compressive Screws

Abstract

Objective: Unstable phalanx fractures are an indication for reduction and fixation. Classic fixation techniques include Kirschner wires (K wires) or plates for osteosynthesis. This investigation has an objective to compare functional and radiological results of patients operated with intramedullary cannulated no head compressive screw (IMS) with a control group of osteosynthesis with dorsal plate or K wire. Materials and Methods: A prospective follow-up of 15 patients operated with IMS between September 2014 and November 2015, with a mean follow-up of 5 months (range, 3-8 months). Patients included were between 18 and 70 years old and had diaphyseal or distal metaphyseal fractures of Proximal or Middle Phalanx; fracture lines transverse or short oblique; unique lesions, without other structure harmed. Those patients where compared with a control group of 15 patients operated with dorsal locking plate in diaphyseal fractures, or with K wire in cases with distal metaphyseal fractures. The final range of movement, immediate postoperative pain and pain at discharge, radiological consolidation, time of labor leave, complications, and satisfaction index at discharge were evaluated. The IMS group corresponded to 16 fractures: 6 diaphyseal and 3 of the distal metaphysis of the Middle Phalanx (P2). 16 fractures of the control group: 8 diaphyseal (treated with plate) and 2 of the distal metaphysis of the Proximal Phalanx (P1, treated with K wires); 3 diaphyseal (treated with plate ) and 3 of the distal metaphysis of the Middle Phalanx (P2, treated with K wires). Results: Total active range of movement of the IMS group P1 was 249° (240°-260°) and 225° (190°-240°) ( P = .01). Total active range of movement of the IMS group P2 was 240° (231-255) and 228° (190-250) ( P = .05). The mean return to work was 50 days (range, 15-64 days) for the IMS group and 60 days for the control group ( P = .1). All fractures of the IMS group had radiological consolidation at discharge, and there were no difference in the time of consolidation with the control group. There were no cases with secondary arthrosis at final follow up. Immediate postoperative pain (0/10) of IMS group was 3 and 0 at discharge and 100% of the IMS classified as “satisfied.” Conclusions: Transverse and short oblique fractures of P1 or P2 may fixate satisfactory with compressive cannulated intramedullary screw. They present a better functional result, less time of labor leave, and same consolidation rate as that of the control group. The index of satisfaction was outstanding. The presence of arthrosis should be evaluated with longer follow up where the screw site of entrance to the bone.