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Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating
PURPOSE: Phalangeal 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 ph...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957854/ https://www.ncbi.nlm.nih.gov/pubmed/35994095 http://dx.doi.org/10.1007/s00402-022-04516-z |
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author | Silins, Kaspars Turkmen, Tutku Vögelin, Esther Haug, Luzian C. P. |
author_facet | Silins, Kaspars Turkmen, Tutku Vögelin, Esther Haug, Luzian C. P. |
author_sort | Silins, Kaspars |
collection | PubMed |
description | PURPOSE: Phalangeal 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 METHODS: Twenty-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. RESULTS: TAM 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. CONCLUSION: Minimally 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. |
format | Online Article Text |
id | pubmed-9957854 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-99578542023-02-26 Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating Silins, Kaspars Turkmen, Tutku Vögelin, Esther Haug, Luzian C. P. Arch Orthop Trauma Surg Handsurgery PURPOSE: Phalangeal 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 METHODS: Twenty-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. RESULTS: TAM 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. CONCLUSION: Minimally 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. Springer Berlin Heidelberg 2022-08-22 2023 /pmc/articles/PMC9957854/ /pubmed/35994095 http://dx.doi.org/10.1007/s00402-022-04516-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Handsurgery Silins, Kaspars Turkmen, Tutku Vögelin, Esther Haug, Luzian C. P. Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title | Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title_full | Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title_fullStr | Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title_full_unstemmed | Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title_short | Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
title_sort | comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating |
topic | Handsurgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957854/ https://www.ncbi.nlm.nih.gov/pubmed/35994095 http://dx.doi.org/10.1007/s00402-022-04516-z |
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