Intramedullary Compression Screw Fixation of Metacarpal and Phalangeal Fractures.

Abstract

Background: Metacarpophalangeal fractures are the second most common fractures of the upper limb after distal radius fractures. These fractures represent 40% of all upper extremity fractures.

Aim of the work: The aim of this work is to examine the outcome (clinical and functional) of intramedullary headless screw (IMHS) fixation for metacarpal and phalangeal fractures.

Patients and methods: This is a prospective case series, which was conducted on (20) patients with (20) fractures admitted from emergency department of Al-Zahraa University hospital and Al-Ahrar Teaching Hospital, Sharkia. All were evaluated clinically in a systematic pattern (history, clinical examination (general and local hand examination), laboratory investigations and radiological workup. All were treated by IMHS for metacarpophalangeal fractures. Follow up visits were performed for at least 3 months after surgery. The outcome was evaluated clinically (functional outcome) and by x-ray imaging (radiological union). The results of the last follow up visit was included in the statistical analysis.

 Results: The patient age ranged from 20 to 55 years with an average of 35.76 years and 7 patients were females. Manual worker was the commonest occupation (20.0%), while diabetes and smoking were the commonest risk factors. Fight was the commonest mode of injury (30%).  DASH score was significantly reduced at 6 months than corresponding values at 3 months (1.26 ± 1.65 vs 2.88 ± 3.07; p < 0.05). The extension lag 6 weeks after surgery was significantly reduced when compared to values at 2 weeks postoperatively (2.64± 5.03 vs 16.18 ± 6.00, respectively).  The return to work was achieved within 5 to 8 weeks, while radiographic union was completed 5-12 weeks after surgery. Complications were reported among 6 patients (30.0%), which were mild and treated conservatively.

Conclusion:  Intramedullary Compression Screw Fixation is a relatively safe and effective treatment option for the Metacarpal and Phalangeal Fractures.