title: Two versus 3 lag screws for fixation of long oblique proximal phalanx fractures of the fingers: a cadaver study.
abstract: OBJECTIVE
  To compare 2- versus 3-screw fixation for oblique fractures of the proximal phalanx in a cadaver model that simulates active finger motion.
  
  
  METHODS
  We experimentally cut the proximal phalanges of the index, middle, and ring fingers of 9 cadaveric hands. Five fingers were assigned to a control group with no fixation, and 22 were fixed with either 2 or 3 lag screws. One digit was excluded because of iatrogenic fracture during preparation. The fingers were fitted with a differential variable reluctance transducer that measured maximum interfragment displacement while the fingers were subjected to 2,000 full flexion and extension cycles to simulate a 6-week active motion protocol.
  
  
  RESULTS
  Analysis of variance revealed a significant difference between the control group and both the 2- and the 3-screw group. The 2- and 3-screw group average displacements were not significantly different. Both of these groups were equivalent with a power of 90%.
  
  
  CONCLUSIONS
  Biomechanical stability during simulated active motion protocol did not differ in simulated proximal phalanx fractures treated with 2 lag screws or 3.
  
  
  CONCLUSIONS
  Fracture fixation using 2 screws may be more cost and time effective and, therefore, more attractive to the surgeon, even when 3 screws can be placed. Furthermore, surgeons may consider using 2 screws rather than resorting to plate fixation when 3-screw fixation is not possible for these types of fractures.
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Zelken
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Austin G
authors.initials: AG
authors.lastname: Hayes
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Brent G
authors.initials: BG
authors.lastname: Parks
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Muhit
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: anne.mattson@medstar.net.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Means
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001863:Bone Screws / Q000706:statistics & numerical data*; D002102:Cadaver; D005260:Female; D050278:Finger Phalanges / Q000293:injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Fracture; lag screw; proximal phalanx; stability