title: Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws.
abstract: OBJECTIVE
  To present the technique, indications, and outcomes of metacarpal and phalangeal fractures fixed with intramedullary cannulated headless screws (CHS).
  
  
  METHODS
  We retrospectively reviewed all charts of patients whose metacarpal and phalangeal fractures had been treated with intramedullary CHS in our practice. A total of 69 fractures (48 metacarpal and 21 phalangeal) were identified in 59 patients. Seventeen were open fractures. Eleven patients had multiple fractures (29 in total); of those, 21 were managed with CHS. In 4 other fractures the method was abandoned intraoperatively. The defect created by the entrance of the screw in the proximal phalanx was identified by computed tomography in 20 patients.
  
  
  RESULTS
  In 63 fractures a single screw was used; in 6 fractures 2 screws were used to provide stronger fixation. All patients returned to full duties or sport activities at an average of 76 days (range, 3 wk to 15 mo). At the latest follow-up (range, 5-54 mo; average, 19 mo) total active motion was on average 247° (range, 150° to 270°) for all fractures, 249° (range, 210° to 270°) for metacarpal, and 243° (range, 150° to 270°) for proximal phalangeal fractures. All fractures were healed and within acceptable radiological parameters. A comminuted basilar phalangeal fracture displaced secondarily yielding a poor functional result. Two patients required tenolysis and further procedures before the final result was achieved. The screw hole represents around 20% of the proximal phalanx distal articular surface.
  
  
  CONCLUSIONS
  Unstable transverse fractures in the phalanx and metacarpal are amenable to single intramedullary CHS fixation. Comminuted fractures require more complex configurations.
  
  
  METHODS
  Therapeutic IV.
authors: Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain. Electronic address: drpinal@drpinal.com.
authors: Francisco
authors: F
authors: del Piñal
authors: Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors: Eduardo
authors: E
authors: Moraleda
authors: Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors: Jaime S
authors: JS
authors: Rúas
authors: Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors: Guillermo H
authors: GH
authors: de Piero
authors: Instituto de Cirugía Plástica y de la Mano and Radiology Section, Private Practice, and Hospital Mutua Montañesa, Santander, Spain.
authors: Luis
authors: L
authors: Cerezal
mesh_terms: D000328:Adult; D001863:Bone Screws; D005260:Female; D050278:Finger Phalanges / Q000293:injuries*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Metacarpal fractures; cannulated screws; intramedullary fixation; open digital fractures; phalangeal fractures