Intramedullary Headless Screw Fixation of Metacarpal Fractures: A Radiographic Analysis for Optimal Screw Choice

Background: The purpose of this study was to investigate variations in radiographic metacarpal anatomy as it relates to intramedullary (IM) fixation of metacarpal fractures and to compare this anatomy with available headless screw dimensions. Methods: We radiographically analyzed posteroanterior and lateral (LAT) radiographs of 120 metacarpals across 30 patients without structural abnormalities. Primary outcomes included IM isthmus diameter, isthmus location, metacarpal cascade, and head entry point collinear with IM canal. Measurements were compared with a list of commercially available headless screws used for IM fixation. Results: The average largest isthmus diameter was in the small metacarpal (3.4 mm), followed by the index (2.8 mm), long (2.7 mm), and ring (2.7 mm) metacarpals. The average cascade angle between long and index, long and ring, and long and small metacarpals was 0°, 24°, and 27°, respectively. The appropriate head entry point ranged between 25% and 35% from the dorsal surface of the metacarpal head on a LAT view. The retrograde isthmus location of the index and long finger was 39.2 and 38.1 mm, respectively. Twenty-five screws from 7 manufacturers were analyzed with sizes ranging from 1.7 to 4.5 mm. Only 8 of 17 screws between 2.3 and 3.5 mm had a length range above 35 mm. Conclusions: Metacarpal head entry point and cascade angle can help identify the appropriate reduction with the guide pin starting point in the dorsal 25% to 35% of the metacarpal head. Surgeons should be mindful to choose the appropriate fixation system in light of the variations between metacarpal isthmus size, isthmus location, and available screw lengths.

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The Universal Entry Point with oblique screw is superior to fixation perpendicular to the physis in moderate slipped capital femoral epiphysis

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190178 ◽

2020 ◽

Vol 14 (5) ◽

pp. 358-363

Author(s):

Jillian Lee ◽

Jonathon A. Lillia ◽

Jeremy M. Bellemore ◽

David G. Little ◽

Tegan L. Cheng

Keyword(s):

Femoral Head ◽

Screw Fixation ◽

Slipped Capital Femoral Epiphysis ◽

Maximum Load ◽

Entry Point ◽

Control Group ◽

Single Screw ◽

Starting Point ◽

Load To Failure ◽

Metaphyseal Bone

Purpose Stable slipped capital femoral epiphysis (SCFE) is often treated with in situ pinning, with the current gold standard being stabilization with a screw perpendicular to the physis. However, this can lead to impingement and a potentially unstable construct. In this study we model the biomechanical effect of two screw positions used for SCFE fixation. We hypothesize that single screw fixation into the centre of the femoral head from the anterior intertrochanteric line (the Universal Entry Point or UEP) provides a more stable construct than single screw fixation perpendicular to the physis with an anterior starting point. Methods Sawbone models of moderate SCFE were used to mechanically test the two screw constructs and an unfixed control group. Models were loaded to failure with a shear load applied through the physis in an Instron mechanical tester. The primary outcomes were maximum load, stiffness and energy to failure. Results Screw fixation into the centre of the femoral head from the UEP resulted in a greater load to failure (+19%), stiffness (+13%) and energy to failure (+45%) than screw fixation perpendicular to the physis. Conclusions In this sawbone construct, screw fixation into the centre of the femoral head from the UEP provides greater biomechanical stability than screw fixation perpendicular to the physis. This approach may also benefit by avoiding an intracapsular entry point in soft metaphyseal bone and subsequent risk of impingement and loss of position.

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Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s021881041750006x ◽

2017 ◽

Vol 22 (01) ◽

pp. 35-38 ◽

Cited By ~ 1

Author(s):

Eichi Itadera ◽

Takahiro Yamazaki

Keyword(s):

Screw Fixation ◽

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Fixation Method ◽

Compression Screw ◽

Metacarpal Head ◽

Headless Compression Screw ◽

Articular Fractures ◽

Intramedullary Canal ◽

Cannulated Drill

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.

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Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03939-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yung-Cheng Chiu ◽

Tsung-Yu Ho ◽

Yen-Nien Ting ◽

Ming-Tzu Tsai ◽

Heng-Li Huang ◽

...

Keyword(s):

Articular Cartilage ◽

Screw Fixation ◽

Shaft Fracture ◽

Metacarpal Bone ◽

Entry Point ◽

Fixation Method ◽

Exit Point ◽

Compression Screw ◽

Headless Compression Screw ◽

Metacarpal Shaft

Abstract Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

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The Harris-Galante porous-coated acetabular component with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199274080-00002 ◽

1992 ◽

Vol 74 (8) ◽

pp. 1130-1139 ◽

Cited By ~ 171

Author(s):

T P Schmalzried ◽

W H Harris

Keyword(s):

Acetabular Component ◽

Screw Fixation ◽

Radiographic Analysis ◽

Hip Replacements

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Comparison of Intramedullary Nailing Versus Plate-Screw Fixation of Extra-Articular Metacarpal Fractures

Yearbook of Orthopedics ◽

10.1016/s0276-1092(09)79585-9 ◽

2009 ◽

Vol 2009 ◽

pp. 153-154

Author(s):

S.D. Trigg

Keyword(s):

Intramedullary Nailing ◽

Screw Fixation ◽

Metacarpal Fractures

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Comparison of Biomechanics of Lumbar-Pelvis Segment With Posterior Screw-Rod Versus Interspinous Plate Fixation System

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19356 ◽

2010 ◽

Author(s):

A. Kiapour ◽

J. O’Donnell ◽

V. K. Goel ◽

A. Biyani

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Screw Fixation ◽

Plate Fixation ◽

Pedicle Screw Fixation ◽

Low Back ◽

Lumbar Degenerative Disease ◽

Segmental Instability ◽

Fixation System ◽

Surgical Option

Spinal fusion is the traditional surgical option to improve the clinical outcome of patients with advanced lumbar degenerative disease. Various techniques including posterolateral arthrodesis, interbody arthrodesis, and circumferential arthrodesis are being pursued as fusion strategies to eliminate segmental instability, which is a recognized cause of low back pain [1]. There are several drawbacks associated with pedicle-screw fixation constructs including failure of implant components and back-out of the screws [2,3].

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Trajectory of Lumbar Translaminar Facet Screw Under Navigation: A Cadaveric Study

Global Spine Journal ◽

10.1177/2192568220962444 ◽

2020 ◽

pp. 219256822096244

Author(s):

Weerasak Singhatanadgige ◽

Kittisak Songthong ◽

Phattareeya Pholprajug ◽

Wicharn Yingsakmongkol ◽

Vit Kotheeranurak ◽

...

Keyword(s):

Minimally Invasive ◽

Facet Joint ◽

Screw Fixation ◽

Spinous Process ◽

Transverse Process ◽

Transforaminal Lumbar Interbody Fusion ◽

Cadaver Study ◽

Lateral Angle ◽

Starting Point ◽

Screw Length

Study Design: Anatomic cadaver study. Objective: Translaminar facet screw fixation supplements unilateral pedicle screw-rod fixation in minimally invasive transforaminal lumbar interbody fusion (TLIF). Various screw diameters, lengths, trajectories, and insertion points are used; however, they do not represent true screw trajectory. We aimed to evaluate lumbar laminar anatomy and suggest a safe and effective insertion point and trajectory during lumbar-translaminar facet screw fixation in an anatomic cadaver study. Methods: O-arm navigation simulating the true translaminar facet screw trajectory was used to evaluate L1-S1 in cadaveric spines. The inner and outer diameters, length, and trajectory of the screw pathway were measured along the trajectory from the spinous process base through the contralateral lamina, crossing the facet joint to the transverse process base using 2 starting points: cephalad one-third (1/3SL) and one-half (1/2SL) of the spinolaminar junction. Results: Using the 1/2SL starting point, the outer and inner lamina diameters did not differ significantly from L1-L5 (7.47 ± 1.38 to 6.7 ± 1.84 mm and 4.73 ± 1.04 to 3.86 ± 1.46 mm, respectively). Screw length (36.16 ± 4.02 to 49.29 ± 10.07 mm) and lateral angle increased (50.28° ± 8.78° to 60.77° ± 8.88°), but caudal angle decreased (16.19° ± 9.01° to 1.13° ± 11.31°). Lamina diameter and screw length did not differ with different starting points. L2-L3 caudal angles were lower in the 1/2SL starting point. Conclusion: A 36- to 50-mm translaminar facet screw—with 5.0-mm diameter for L1-L2 and 4.5-mm diameter for L3-L5—can be inserted at the middle of the spinolamina, especially during minimally invasive TLIF, with a 50° to 60° lateral angle relative to the spinous process, and a caudal angle of 16° to 1° relative to the spinolamina from L1-L5.

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Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures

Hand ◽

10.1177/1558944719836214 ◽

2019 ◽

Vol 15 (6) ◽

pp. 798-804 ◽

Cited By ~ 1

Author(s):

William J. Warrender ◽

David E. Ruchelsman ◽

Michael G. Livesey ◽

Chaitanya S. Mudgal ◽

Michael Rivlin

Keyword(s):

Screw Fixation ◽

Case Series ◽

Compression Screw ◽

Nickel Allergy ◽

Hardware Failure ◽

Metacarpal Fractures ◽

Headless Compression Screw ◽

Clinical Complications ◽

Headless Compression Screws ◽

Low Incidence

Background: There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. Methods: We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Results: Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Conclusion: Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.

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