Headless Compression Screw Fixation of Jones Fractures

Category: Sports Introduction/Purpose: There remains controversy over the ideal implant for intramedullary screw fixation of fifth metatarsal Jones fractures. Promising results have separately been reported for both indication-specific partially threaded screws and headless compression screws. The purpose of this study was to compare clinical and radiographic results between Jones fracture patients treated with indication-specific partially threaded screws to variable-pitched headless compression screws. We also evaluated the association of various patient and fracture characteristics with surgical failure. Methods: We performed a retrospective review and comparative analyses of all Jones fractures treated with primary intramedullary screw fixation by 4 foot and ankle fellowship-trained orthopaedic surgeons at a single institution from 1995 through 2015. Exclusion criteria included concomitant foot or ankle procedures and revision surgery. Charts were reviewed for patient and injury characteristics, implant, and postoperative course. Serial radiographs were examined for fracture classification (Torg and anatomic zone) and radiographic union. Primary endpoint was number of surgical failures, defined as delayed union, nonunion, or refracture. Secondary endpoints included time to each of radiographic union, weight bearing, and pain resolution. Data were analyzed using independent T test, one-way ANOVA, chi-square, and correlation analyses with significance defined as p < 0.05. Results: Fifty-nine feet were reviewed with mean age 30 years and follow-up 9.6 months. Forty-seven received a partially threaded screw (PT) and 12 feet a headless compression screw (HC). The PT group had more failures (10/47, 21.3% vs. 1/12, 8.3%; p=0.31) and more weeks to full weight (4.2 vs. 3.3, p=0.06), without significant differences in time to radiographic union or pain resolution. Most failures were delayed unions. Pooled union rate was 96.6%. Correlated with failure were age (r=0.469, p < 0.001), diabetes (r=0.390, p=0.002), and BMI (r=0.281, p=0.03), without significant correlation for tobacco, gender, or weight. Compared to Torg 1 and 2, Torg 3 fractures had greater time to pain resolution and radiographic union, age, weight, and BMI. No differences were found between zone II and III fractures. Conclusion: To our knowledge, this is the first reported clinical comparison between indication-specific partially threaded screws (PT) and headless compression screws (HC) for treating Jones fractures. This is also one of the largest clinical series on the subject. The two groups had similar clinical and radiographic results, both with high union rates. While most failures were delayed unions that ultimately healed, the 21% failure rate in the PT group is concerning and may warrant further investigation. Increasing patient age, diabetes, and BMI were associated with worse outcomes. These data support headless compression screw fixation as a viable treatment for Jones fractures.

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Single Versus Dual Headless Compression Screw Fixation of Scaphoid Nonunions: A Biomechanical Comparison

Hand ◽

10.1177/1558944720974111 ◽

2021 ◽

pp. 155894472097411

Author(s):

Luke T. Nicholson ◽

Kristen M. Sochol ◽

Ali Azad ◽

Ram Kiran Alluri ◽

J. Ryan Hill ◽

...

Keyword(s):

Screw Fixation ◽

Qualitative Assessment ◽

Secondary Outcome ◽

Scaphoid Nonunion ◽

Compression Screw ◽

Single Screw ◽

Headless Compression Screw ◽

Significant Difference ◽

Load To Failure ◽

Headless Compression Screws

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct. Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure. Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( P = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( P = .029). Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.

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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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Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416641319 ◽

2016 ◽

Vol 41 (7) ◽

pp. 683-687 ◽

Cited By ~ 12

Author(s):

P. Borbas ◽

M. Dreu ◽

A. Poggetti ◽

M. Calcagni ◽

T. Giesen

Keyword(s):

Articular Surface ◽

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Cadaver Study ◽

Compression Screw ◽

Headless Compression Screw ◽

Headless Compression Screws ◽

Average Defect ◽

Phalangeal Fractures ◽

Intramedullary Screw

The aim of this study was to quantify the articular cartilage defect created with two different antegrade techniques of intramedullary osteosynthesis with a headless compression screw inserted through the metacarpophalangeal joint. In 12 out of 24 fingers from six cadaveric hands, a trans-articular technique with cannulated headless compression screws (2.2 and 3.0 mm diameter) was used; whereas in the other 12 fingers, an intra-articular fixation technique was used. The areas of the articular surface and the defects created were measured with a digital image software program. All measurements were made twice by two observers. In the intra-articular technique, the average defect in the base of the articular surface of the proximal phalanx was 4.6% with the 2.2 mm headless compression screw and 8.5% with the 3.0 mm screw. In the trans-articular technique, the defect size was slightly smaller; 4.2% with the 2.2 mm screw and 8% with the 3.0 mm screw, but the differences were not statistically significant. The main advantage of the intra-articular technique was that it avoided damage to the articular surface of the metacarpal head.

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Headless Compression Screw Fixation of Delayed Union Jones Fractures: A Case Series

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.8140 ◽

2021 ◽

Vol 23 (2) ◽

pp. 121-127

Author(s):

Ahmed Nagi ◽

Mosab Elgalli ◽

Islam Mubark ◽

Bahaa A. Motawea ◽

Charalampos Karagkevrekis

Keyword(s):

Screw Fixation ◽

Short Form ◽

Case Series ◽

Functional Results ◽

Delayed Union ◽

Compression Screw ◽

Variable Pitch ◽

Non Union ◽

Headless Compression Screw ◽

Case Series Study

Background. Different methods have been adopted to treat delayed union and non-union of fractures of the base of the fifth metatarsal using screws, plates and tension band wires. There has been increasing use of intramedullary screw fixation to treat these fractures with variable rates of success. The optimum screw diameter and properties have been a subject of debate. To assess the results of using a larger diameter 5.5 mm cannulated, headless variable-pitch screw to fix delayed union of Jones fracture of the base of the fifth metatarsal. Methods and methods. A case series study including 24 patients with delayed union of Jones fifth metatarsal fractures. The fractures were fixed by a 5.5 mm cannulated variable-pitch compression titanium screw (Acumed® Acutrak 2® Screw System). Results. Radiological union was achieved in all patients at a mean of 7.2 weeks. At 12 months’ follow up, patients had a mean American Orthopedic Foot & Ankle Society midfoot score of 95.6. The mean Short Form 12 Physical and mental survey scores improved from 22.71 and 29.31 points preoperatively to 57.88 and 59.54 respectively. Conclusion.The headless compression screw achieved a satisfactory union rate for delayed union Lawrence zone II fractures of the base of the fifth metatarsal with satisfactory functional results.

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An Unexpected Complication after Headless Compression Screw Fixation of an Osteochondral Fracture of Patella

Case Reports in Orthopedics ◽

10.1155/2016/7290104 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Suavi Aydoğmuş ◽

Tahir Mutlu Duymuş ◽

Tolga Keçeci

Keyword(s):

Patellar Dislocation ◽

Screw Fixation ◽

Cartilage Thickness ◽

X Rays ◽

Compression Screw ◽

Cartilage Surface ◽

Fracture Fragment ◽

Osteochondral Fracture ◽

Headless Compression Screw ◽

Headless Compression Screws

This study evaluated complications associated with implant depth in headless compression screw treatment of an osteochondral fracture associated with a traumatic patellar dislocation in a 21-year-old woman. Computed tomography and X-rays showed one lateral fracture fragment measuring 25 × 16 mm. Osteosynthesis was performed with two headless compression screws. Five months later, the screws were removed because of patella-femoral implant friction. We recommend that the screw heads be embedded to a depth of at least 3 mm below the cartilage surface. Further clinical studies need to examine the variation in cartilage thickness in the fracture fragment.

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Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures

Foot & Ankle International ◽

10.1177/1071100720953083 ◽

2020 ◽

pp. 107110072095308

Author(s):

Bryan A. Bean ◽

Niall A. Smyth ◽

Pooyan Abbasi ◽

Brent G. Parks ◽

Walter C. Hembree

Keyword(s):

Weight Bearing ◽

Plantar Fascia ◽

Hook Plate ◽

Bony Union ◽

Compression Screw ◽

Avulsion Fractures ◽

Headless Compression Screw ◽

Plate Group ◽

Headless Compression Screws ◽

Fresh Frozen

Background: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. Methods: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. Results: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. Conclusion: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. Clinical Relevance: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.

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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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Metacarpal Bony Dimensions Related to Headless Compression Screw Sizes

Journal of Hand and Microsurgery ◽

10.1055/s-0039-3400443 ◽

2019 ◽

Vol 12 (S 01) ◽

pp. S39-S44

Author(s):

Michael Okoli ◽

Kevin Lutsky ◽

Michael Rivlin ◽

Brian Katt ◽

Pedro Beredjiklian

Keyword(s):

Computed Tomography ◽

Fracture Fixation ◽

Ct Scans ◽

Compression Screw ◽

Metacarpal Head ◽

Headless Compression Screw ◽

Metacarpal Bones ◽

Headless Compression Screws ◽

The Mean ◽

Distal Aspect

Abstract Introduction The purpose of this study is to determine the radiographic dimensions of the finger metacarpals and to compare these measurements with headless compression screws commonly used for fracture fixation. Materials and Methods We analyzed computed tomography (CT) scans of the index, long, ring, and small metacarpal bones and measured the metacarpal length, distance from the isthmus to the metacarpal head, and intramedullary diameter of the isthmus. Metacarpals with previous fractures or hardware were excluded. We compared these dimensions with the size of several commercially available headless screws used for intramedullary fixation. Results A total of 223 metacarpals from 57 patients were analyzed. The index metacarpal was the longest, averaging 67.6 mm in length. The mean distance from the most distal aspect of the metacarpal head to the isthmus was 40.3, 39.5, 34.4, and 31 mm for the index, long, ring, and small metacarpals, respectively. The narrowest diameter of the isthmus was a mean of 2.6, 2.7, 2.3, and 3 mm for the index, long, ring, and small metacarpals, respectively. Of 33 commercially available screws, only 27% percent reached the isthmus of the index metacarpal followed by 42, 48, and 58% in the long, ring, and small metacarpals, respectively. Conclusion The index and long metacarpals are at a particular risk of screw mismatch given their relatively long lengths and narrow isthmus diameters.

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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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Compression Screw Fixation of Lunate Fracture: Case Report and Review of the Literature

Journal of Wrist Surgery ◽

10.1055/s-0041-1733878 ◽

2021 ◽

Author(s):

Hassan A. Qureshi ◽

Kashyap Komarraju Tadisina ◽

Gianfranco Frojo ◽

Kyle Y. Xu ◽

Bruce A. Kraemer

Keyword(s):

Literature Review ◽

Screw Fixation ◽

Carpal Bone ◽

Compression Screw ◽

Left Hand ◽

Headless Compression Screw ◽

Limited Experience ◽

Fracture Management ◽

Initial Injury ◽

Fracture Compression

Abstract Background Isolated traumatic lunate fractures without other surgical carpal bone or ligamentous injuries are extremely rare, with few published reports available to guide management. Lunate fracture management is controversial, and depends on concurrent injuries of adjacent carpal bones, ligaments, risk of ischemia, and displacement. Case Description A 48-year-old right hand dominant man suffered a crush injury to the left hand caught between a forklift and a metal shelf. Radiographs and computed tomography imaging of the left hand and wrist were significant for a displaced Teisen IV fracture of the lunate. A dorsal ligament sparing approach was utilized to access, reduce, and fixate the fracture using a headless compression screw. After immobilization and rehab, at 9 months after initial injury, the patient was back to work on full duty without restriction and pleased with the results of his treatment. Literature Review A literature review of lunate fracture compression screw fixation was performed and revealed a total of three reports indicating successful treatment of fractures, with patients returning to full activity. Clinical Relevance Lunate fractures are rare, often missed, and treating these injuries can be challenging, particularly in the setting of acute trauma. Based on our limited experience, we believe that open reduction and internal fixation of isolated Teisen IV lunate fractures with a headless compression screw is a viable treatment modality with satisfactory outcomes.

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