Intramedullary Headless Screw Research Articles

Intra-Articular Antegrade Intramedullary Screw Fixation for Proximal Phalanx Fractures: Impact of Articular Surface Defects on Joint Contact Pressures.

Intramedullary headless screw fixation is increasingly used for fixation of proximal phalanx fractures. However, the impact of screw entry defects on joint contact pressures is not well defined and may have implications for arthrosis. The objective of this cadaveric biomechanical study was to assess joint contact pressures at the metacarpophalangeal (MCP) joint before and after passage of 2 sizes of antegrade intramedullary fixation. Seven fresh frozen cadaver specimens without arthritis or deformity were included in this study. Antegrade intramedullary screw fixation of proximal phalanx fracture was simulated using an intra-articular technique. Flexible pressure sensors were inserted into the MCP joints and cyclic loading was performed. Peak contact pressures were determined and averaged across loading cycles for each finger in the native state, with 2.4- and 3.5-mm drill defects in line with the medullary canal. Peak pressure increased with the size of the drill hole defect. Contact pressure increases were greater in extension, with peak contact pressures increased by 24% for the 2.4-mm defect and 52% for the 3.5-mm defect. Increase in peak contact pressure was statistically significant with a 3.5-mm articular defect. Contact pressures were not consistently increased for the 2.4-mm defect. Testing in flexion of 45° resulted in reduced contact pressure for these defects. Our study demonstrates that antegrade intramedullary fixation of proximal phalanx fractures can increase MCP joint peak contact pressures, particularly in an extended joint position. Effect increases with defect size. This has implications for the management of proximal phalanx fractures using this technique.

Intramedullary Fixation with Cannulated Screw After Resection of Enchondroma in the Hand: Technique Description and Case Series

Enchondromas are primary, benign bone neoplasms that arise from intramedullary proliferation of hyaline cartilage cells. Slow and progressive in growth, enchondromas can lead to bone destruction, deformities, and fractures. The treatment of enchondromas remains controversial. We hereby describe the technique for bone fixation using headless intramedullary screws (HISs) after enchondroma resection in the long bones of the hand. From January 2018 to June 2021, all patients treated with HISs after the resection of enchondroma of the hand were retrospectively assessed and included in the study. The series comprised four patients with a minimum postoperative follow-up period of 12 months. Postoperative functional results were measured according to Takigawa criteria and postoperative radiographic results were graded according to the Tordai system. After tumor resection and screw fixation, one patient had autologous bone grafting from the iliac crest, and another had the defect filled with calcium phosphate cement. All patients were followed up for at least 12 months, and the mean healing time of the pathologic fracture was 5 weeks. There were neither complications related to the procedure nor the need for a second surgery. We describe the technique of intramedullary headless screws for bone fixation after enchondroma resection in the long bones of the hand, as well as the excellent functional, cosmetic, and radiographic results of four patients treated with the technique presented herewith. Therapeutic IV.

Intramedullary Headless Screw Fixation for Metacarpal Fractures - Technical Tips.

Metacarpal fractures are a common injury in the hand. When surgical intervention is indicated, there are multiple approaches and techniques of fixation. Intramedullary fixation has become an increasingly versatile method of fixation. The limited dissection needed for its insertion, rotational stability provided by the isthmic fit and lack of requisite hardware removal are improvements over conventional K-wire or plate fixation techniques. Multiple outcome studies have confirmed its safety and effectiveness. In this technical note, we provide some tips that can help surgeons considering intramedullary headless screw fixation of metacarpal fractures. Level of Evidence: Level V (Therapeutic).

Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature.

Fractures of the phalanges can often be managed nonoperatively, but displaced phalangeal fracture patterns, including malrotation, are more amenable to operative treatment. There are several described methods for surgical management of phalanx fractures, but there remains no consensus on a clearly superior method of fixation. Percutaneous Kirschner wires, interfragmentary screws, plate and screw constructs, intramedullary nails, and cannulated intramedullary headless screws are all utilized in the treatment of these fractures. Intramedullary headless screws for phalanx fractures may provide suitable fixation allowing early motion and recovery. Here, we describe a technique for antegrade and retrograde intramedullary headless screw fixation for phalanx fractures.

Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating

PurposePhalangeal fractures are the most common injuries in humans and account for approximately 10% of all fractures. With plate fixation, anatomic reduction is achievable in most cases, but extension lag is seen in up to 67%. Intramedullary headless screw offers treatment of unstable proximal phalangeal fractures using a minimally invasive procedure with very few complications. One of the major disadvantages of this technique is the transarticular screw position, damaging the articular surface and thus preventing very proximal fractures from being treated with a distally inserted screw. In this study, we present a modified approach to the fixation of the proximal phalangeal fractures and compare outcomes with plate osteosynthesis.Materials and methodsTwenty-nine patients with 31 comparable fractures of the proximal phalanx were treated either with a plate (14) or with minimal invasive cannulated compression screw (17). Pain, strength, range of motion (ROM), work disability and QuickDASH score were assessed.ResultsTAM was significantly better in the screw group. The extension lag was worse in the plate group. Plate removal had to be performed in 13 of 14 the cases, while the screw had to be removed in only 3 cases. The average duration of work disability was 9.9 weeks in the plate group, compared to 5.6 weeks in the screw group.ConclusionMinimally invasive screw osteosynthesis not only has the advantage of significantly shorter work disabilities, but also shows remarkably improved postoperative range of motion. In contrast to plate osteosynthesis, removal of the screw is only necessary in exceptional cases. With the antegrade screws position, even difficult fractures close to the base can be treated without destroying any articular surface. In proximal phalanx fractures with both options of plate or single-screw osteosynthesis, we recommend minimal invasive cannulated screw osteosynthesis.

Morphometric Evaluation of Second to Fifth Metacarpals for Retrograde Intramedullary Headless Screw Fixation

Intramedullary headless screw fixation has come to the fore in the treatment of metacarpal fractures in recent years with its advantages. Our aim was to evaluate the metacarpal morphometry for retrograde intramedullary entrance and to determine the optimal entry point. Computed tomography images of 105 patients including 64 men and 41 women, were examined. Distal and proximal metacarpal widths, medullary cavity width, cortex thickness and the measurements of the optimal entry site in volar-dorsal and radio-ulnar directions were measured in both coronal and sagittal planes. In the sagittal plane, the second metacarpal had the widest proximal width (16.29 mm), distal width was greatest in the third metacarpal (14.34 mm) which was significantly different between the sexes (p<0.001). Third metacarpal had the widest medullary cavity width in the sagittal plane (4.12 mm). In the coronal plane, it was the second metarcarpal with the widest proximal (16.14 mm) and distal width (13.92 mm) and was also the longest (66.32 mm). Unlike the sagittal plane, the medullary cavity width in the coronal plane was at the widest (4.06 mm) in fifth metacarpal. The points determined for optimal entry were respectively (4.60 mm; 4.97 mm; 4.55 mm; 4.36 mm) in the dorsal-volar plane, close to the dorsal side. There was no significant difference between the sexes for optimal insertion point in the sagittal planes in all the measured metacarpals. Considering its three dimensional structure, metacarpal bones have irregular morphometric properties and these features differ in sagittal and coronal planes. The optimal entry site is located in the midline in the coronal plane, while it is located in the sagittal plane close to the dorsal part. Knowing these properties can reduce the complication rate by reducing entry attempts and help select the correct material.

Extra-articular mini-open proximal phalanx osteotomy with retrograde intramedullary headless screw under WALANT — Surgical technical

We report on the surgical technique for mini-open derotation osteotomy using retrograde osteosynthesis by headless compression screw under WALANT anesthesia (video attached). Preoperative CT showed the feasibility of this technique, with a 2.2 mm headless compression screw. The mechanical stability of the resulting constructs combined with intraoperative active motion testing under WALANT authorized immediate rehabilitation without immobilization, thus preventing stiffness. Joint range of motion recovered by day 4 and bone consolidation was achieved at 30 days.

Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires.

The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

BackgroundMetacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.ObjectiveWe propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.Materials and methodsWe used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.ResultsThe maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.ConclusionHeadless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up.

Surgical treatment of extra-articular metacarpal and phalangeal fractures should be considered when there is instability or in patients with high demand. To overcome the issues related to the use of Kirschner wires, external fixators, and open reduction and internal fixation procedures, intramedullary headless screw fixation (IHSF) is an alternative technique to achieve primary fracture stability and early return to daily activities. We report the data of the Italian Multicentric Intra-Medullary Experience, which includes 173 cases of extra-articular unstable fractures (38 phalanges and 135 metacarpals) treated with the IHSF. After surgery, patients underwent early mobilization without splinting. The results confirm the reliability of IHSF in cases with non-articular involvement, showing a good recovery rate in terms of bone healing and range of motion.Level of evidence: IV.

In vitro Biomechanical Analysis of Proximal Phalangeal Osteotomy Fixation.

Background Corrective osteotomies of the proximal phalanx are typically stabilized with plate and screws. Although intramedullary headless screws form an alternative fixation method in the treatment of acute phalangeal fractures, reports about fixation of opening wedge corrective osteotomies with these implants are lacking. Objective The goal of the present study was to biomechanically compare the failure force of both fixation methods for this specific indication. Methods Twenty-four cadaver phalanges were equally distributed between apex volar and apex lateral opening wedge osteotomy groups. In each group, half of the osteotomies were fixed with a 1.3-mm dorsal locking plate, the other half with a 2.4-mm intramedullary headless screw. A three-point bending test was performed. Results The mean maximal failure force after apex lateral osteotomy was 178.4 N for the plate-screw construct and 144.0 N after intramedullary headless screw fixation. After apex volar osteotomy, mean maximal force was 237.6 N in the plate-screw group and 160.9 N in the intramedullary headless screw group. Mean stiffness after apex lateral osteotomy was 63.3 N/mm in the plate-screw group, and 55.9 N/mm in the intramedullary headless screw group. Mean stiffness after apex volar osteotomy was 197.5 N/mm and 60.0 N/mm for the plate-screw and intramedullary headless screw group, respectively. Conclusion For apex volar osteotomies, dorsally applied angular stable plate and screws provide significantly stronger fixation than intramedullary headless screws. For apex lateral osteotomies, fixation force is comparable. Clinical relevance These data are useful when considering fixation of opening wedge osteotomies with intramedullary screws.

Intramedullary Headless Screw Fixation of Distal Metacarpal Fractures – the Birmingham Experience

Background: Surgical fixation using intramedullary headless screws (IHS) is a relatively new technique for metacarpal fracture repair. However, there are very few studies investigating the outcomes of this procedure. We present the surgical and functional outcomes of a consecutive series of 30 metacarpal fractures treated by a single surgeon over a 2.5-year period using IHS. Methods: We retrospectively reviewed the records of 30 metacarpal fractures in 27 patients who underwent IHS fixation from March 2016 to October 2018. There were 29 fractures of the metacarpal neck and 1 was to the metacarpal head. All fractures underwent the procedure by a single operating surgeon. Individual joint movements along with total active movement (TAM) was measured at postoperative follow-up appointments 4-8 weeks after surgery. Fracture healing was confirmed with plain radio-graphs. Patients were also recalled in March 2019 for their latest functional measurements. A QuickDASH (disabilities of the arm, shoulder and hand) questionnaire was used to assess for any residual functional disability. Results: All fractures healed within acceptable radiological parameters with no mal-unions or rotational deformities. The average TAM at initial follow-up was 245°, which improved to 264° at the March 2019 review. All patients returned to work in an average of 6 weeks. The final functional QuickDASH score was an average of 2.9/100 (range 0-18.2). 2/27 patients required further surgery for stiffness before regaining excellent TAM. No patient required metalwork removal. There were no other complications. Conclusions: Our findings suggest that IHS fixation is an effective alternative technique for the treatment of metacarpal fractures. It is a relatively simple procedure, which provides good stable fixation, allowing for early mobilisation. It has few complications and does not routinely require removal of the implant.

Retrograde intramedullary headless compression screws for treatment of extra-articular thumb metacarpal base fractures.

The purpose of the study was to evaluate clinical and radiological outcomes of extra-articular fractures involving the base of the thumb metacarpal treated with fixation using a retrograde intramedullary cannulated headless screw. A review of prospectively collected data was conducted on a consecutive series of 13 patients, treated with headless screw fixation for acute displaced fractures. All workers resumed full duties, while non-workers returned to unlimited leisure activities within a mean of 42days. At 3months follow-up, all range of motion measurements in the treated and untreated thumb were similar. Mean visual analogue pain score was 0.8 at rest and 1.4 during exercise and mean Quick Disabilities of the Arm, Shoulder, and Hand score was 5. All patients achieved radiographic union by 8weeks. We conclude that the intramedullary headless screw fixation is safe and reliable for base of thumb metacarpal fractures, allowing for early postoperative motion and good functional recovery. Level of evidence: IV.

Fixation of Metacarpal Fractures Using Intramedullary Headless Compression Screws: A Tertiary Care Institution Experience.

IntroductionMetacarpal fractures account for the majority of hand fractures. Inadequate management can cause functional deficit which can lead to loss of fine hand movements. Adequate management has proven to give good outcomes. The use of intramedullary screws has given better results than the use of Kirschner wires (K-wires).MethodThis study was conducted at Dr. Ruth Phau Civil Hospital, Karachi (CHK) between August 1, 2018 and January 31, 2019. A total of 32 patients presented with metacarpal fractures. They were surgically managed with intramedullary headless screw fixation. Post-operatively, grip strength, range of motion, and presence of any disabilities were recorded. Patients were followed up to three months.ResultsOut of 32 patients, six were females. Mean age was found to be 29.1 ± 10.5 years. Post-operatively the mean grip strength was found to be 37.8 ± 7.3 kilograms. The mean total active range of motion was found to be 242.8 ±14.5 degrees. The mean days to return back to work were 25 ± 5.4 days. The mean patient satisfaction score was 8.1 ± 0.79. Three patients developed post-operative stiffness of the joint.ConclusionPatients with intramedullary screw fixation have good post-operative results with early return to work.

Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures.

Background: There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. Methods: We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Results: Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Conclusion: Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.

Clinical Outcomes of Limited Open Intramedullary Headless Screw Fixation of Metacarpal Fractures in 91 Consecutive Patients.

Background: The objective of the study is to evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw (IMHS) fixation for metacarpal neck and shaft fractures. Methods: Retrospective review of 91 consecutive patients (79 men; 12 women), mean age 28 (range =15-69) years, treated with IMHS fixation for acute displaced metacarpal neck (N = 56) and shaft (N = 35) fractures at a single institution. Mean follow-up was 10 (range = 1-71, median = 3) months. Preoperative mean magnitude of metacarpal neck angulation was 48° (range = 0°-90°), and mean shaft angulation was 42° (range = 0°-70°). Active motion was initiated within 5 days postoperatively. Clinical outcomes were assessed with digital goniometry, grip strength, and return to full activity. The time to radiographic union and radiographic arthrosis was assessed. Results: All 91 patients achieved full functional arc of metacarpophalangeal (MCP) motion, and all achieved full active MCP extension or hyperextension. At mean follow-up of 10 months, postoperative mean MCP joint flexion-extension arc was 88° (range = 55°-110°). Grip strength was available for 52 patients and measured 104.1% of the contralateral hand (range = 58%-230%). Radiographic union data were available for 86 patients. Seventy-six percent (65/86) achieved radiographic union by the end of week 6 (range = 2-10 weeks). Early arthrosis was noted in 1 patient at the MCP. There were 3 cases of shaft refracture after recurrent blunt trauma, following prior evidence of full osseous union. Conclusions: The IMHS fixation is safe, reliable, and durable for metacarpal neck/subcapital, axially stable shaft fractures, and select delayed unions or malunions. It allows for early postoperative motion without affecting union rates and obviates immobilization. This technique offers distinct advantages over formal open reduction and percutaneous Kirschner wire techniques.

Percutaneous Intramedullary Headless Screw Fixation and Wide-Awake Anesthesia to Treat Metacarpal Fractures: Early Results in 25 Patients.

Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures require fixation with Kirschner wire (K-wires), plate, and screws. However, these approaches may cause scarring and adhesion with poor functional results. From 2014 to 2015, the authors used an intramedullary headless screw to treat 25 patients (24 men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone. One case presented a multiple metacarpal and phalangeal facture associated. The authors used wide-awake anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter). No open reduction was needed. Early active mobilization started with a buddy strapping soon after surgery (0-3 days). The authors followed all patients until satisfactory function was achieved (4-6 weeks) and recorded the time till return to work. All fracture healed with less than 5 degrees of rotational or axial deformities. All patients return to work within 2.38 weeks after surgery (0.5-6 weeks). No cases of complex regional pain syndrome (CRPS), tendon lesions, nerve injuries, infection, hardware protruding, or mobilization were reported. Intramedullary screw fixation with wide-awake anesthesia for transverse, oblique, and select comminuted fractures treatment metacarpal fractures represent a reliable option to early active mobilization recovery and a quick return to the work and ordinary activities.

Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures.

Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers' compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws.

Introduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.

Commentary on 'Intramedullary headless screw fixation for fractures of the proximal and middle phalanges in the digits of the hand: a review of 31 consecutive fractures' and 'Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study'.

Commentary on 'Intramedullary headless screw fixation for fractures of the proximal and middle phalanges in the digits of the hand: a review of 31 consecutive fractures' and 'Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study'.