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Abbot H, George AR, McCarron L, Graham DJ, Sivakumar B. Intramedullary Screw Fixation of Proximal Phalangeal Fractures: Short- to Medium-term Outcomes. Hand (N Y) 2024:15589447241235339. [PMID: 38491777 DOI: 10.1177/15589447241235339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intramedullary screw fixation of phalangeal and metacarpal fractures has gained popularity as a method of providing rigid internal fixation with minimum tendon disturbance, allowing early mobilization and rehabilitation. Despite this, the literature on outcomes using this technique is limited. Thus, the aim of this study was to assess the short-term to medium-term outcomes of intramedullary screw fixation for proximal phalangeal fracture fixation in an Australian setting. METHODS A retrospective analysis of consecutive patients with a fracture(s) of the proximal phalanx fixated using intramedullary screws between January 2020 and March 2023 was conducted via telehealth. RESULTS Forty-six phalangeal fractures from 37 patients were included in this study. Mean Quick Disabilities of the Arm, Shoulder, and Hand score of 6.2 (range: 0-61.4, median: 0), mean pain visual analogue scale score of 1.8 (range: 1-7, median: 1), and mean total active motion of 231° (range: 132-282) were noted. A total of 4.4% of fractures sustained a major complication, and 94.6% of patients reported willingness to undergo intramedullary screw fixation again. CONCLUSION This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. Superior clinical outcomes, as well as cost-effectiveness and time-effectiveness, render it a viable alternative to plate fixation in this setting.
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Affiliation(s)
- Hagen Abbot
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adam R George
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Herston, Australia
| | - Brahman Sivakumar
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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Sivakumar B, Graham DJ, Clarke E. Dorsal Plating, Lateral Plating, and Intramedullary Screw Fixation of Extra-Articular Proximal Phalangeal Fractures: A Cadaveric Biomechanical Comparison. J Hand Surg Am 2024; 49:247-252. [PMID: 38206273 DOI: 10.1016/j.jhsa.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To provide a biomechanical comparison of dorsal plating, lateral plating and intramedullary screw [IMS] fixation for extra-articular proximal phalangeal fractures. METHODS Midshaft osteotomies were performed on 36 cadaveric proximal phalanges. The phalanges were fixed by dorsal plating, lateral plating or IMS fixation, and subjected to a four-point bending force. Force was applied to achieve displacement of 1 mm/s, until construct failure or to a maximum of 10 mm of displacement. Clinical failure was defined as 2 mm of displacement, and force required to result in 1 mm and 2 mm of displacement was recorded, as was mode of failure. RESULTS Dorsal plating [127.5 N ± 52.6; 46.51-229.17] and lateral plating [77.1 N ± 25.1; 48.3-113.8] required significantly greater force to achieve 1 mm of displacement when compared to IMS [41.2 N ± 12.4; 20.6-62.3]. Dorsal plating [339.2 N ± 91.8; 158.5-538.6] required significantly greater force than lateral plating [154.5 N ± 33.8; 99.0 -204.4] and intramedullary screw fixation [110.0 ± 38.6; 51.1-189.3] to result in 2 mm of displacement. Lateral and dorsal plating constructs failed through plate bending, screw cut-out or plate failure, whilst IMS failed via implant deformity. All three constructs required greater force to result in even 1 mm of displacement than what is likely subjected through rehabilitation via active motion. CONCLUSIONS Lateral plating and IMS fixation offer sufficient stiffness to withstand the likely forces subjected via early active motion without displacement. CLINICAL RELEVANCE Dorsal plating required significantly greater force than lateral plating and intramedullary screw fixation to achieve 1 mm of displacement when used in extra-articular proximal phalangeal fractures in an in vitro setting. However, all three modalities confer enough stability to likely withstand the forces associated with active range of motion.
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Affiliation(s)
- Brahman Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; Department of Surgery, Faculty of Medicine, the University of Sydney, Camperdown, NSW, Australia
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; Department of Musculoskeletal Services, Gold Coast University Hospital, Southport QLD Australia; Griffith University School of Medicine and Dentistry, Southport, QLD, Australia; Department of Orthopaedic Surgery, Northern Beaches Hospital, Frenchs Forrest, NSW, Australia; Department of Medicine, University of Queensland, Herston, QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia.
| | - Elizabeth Clarke
- Murray Maxwell Biomechanics Laboratory, Kolling Institute, University of Sydney, Camperdown, NSW Australia
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George AR, Abbot H, McCarron L, Graham DJ, Sivakumar BS. Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures. J Hand Surg Am 2024:S0363-5023(23)00690-1. [PMID: 38310510 DOI: 10.1016/j.jhsa.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures. METHODS A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature. RESULTS Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort. CONCLUSION Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Adam R George
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Hagen Abbot
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia; Griffith University School of Medicine and Dentistry, Southport, QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Brahman S Sivakumar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia; Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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