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

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.

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

2017 ◽  
Vol 22 (01) ◽  
pp. 35-38 ◽  
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.

scholarly journals Intramedullary compression screw fixation of metacarpal and phalangeal fractures

2020 ◽  
Vol 5 (10) ◽  
pp. 624-629
Author(s):  
Marco Guidi ◽  
Florian S. Frueh ◽  
Inga Besmens ◽  
Maurizio Calcagni
Keyword(s):  
Screw Fixation ◽  
Plate Fixation ◽  
Kirschner Wire ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Articular Fractures ◽  
Metacarpal Shaft ◽  
Screw Breakage ◽  
Phalangeal Fractures ◽  
Transverse Fractures

The intramedullary headless compression screw (IMCS) technique represents a reliable alternative to percutaneous Kirschner-wire and plate fixation with minimal complications. Transverse fractures of the metacarpal shaft represent a good indication for this technique. Non-comminuted subcapital and short oblique fractures can also be treated with IMCS. This technique should not be used in the presence of an open epiphysis, infection and, most of all, in subchondral fractures, because of the lack of purchase for the head of the screw. A double screw construct is recommended for comminuted subcapital fractures of the metacarpal to avoid metacarpal shortening. IMCS can even be applied for peri-articular fractures of the proximal third of the phalanx and in some multi-fragmentary proximal and middle phalangeal fractures. Usually the intramedullary screws are not removed. The main indications for screw removal are joint protrusion, infection and screw breakage after new fracture. Cite this article: EFORT Open Rev 2020;5:624-629. DOI: 10.1302/2058-5241.5.190068

Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures

2021 ◽  
pp. 175319342110177
Author(s):  
John G. Galbraith ◽  
Lachlan S. Huntington ◽  
Paul Borbas ◽  
David C. Ackland ◽  
Stephen K. Tham ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Peak Load ◽  
Torsional Stiffness ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Metacarpal Shaft ◽  
Wire Fixation ◽  
Load To Failure ◽  
Cantilever Bending ◽  
Dorsal Plating

We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation. Transverse mid-diaphyseal fractures were created in 64 metacarpal sawbones and were assigned into four groups. Peak load to failure and stiffness were measured in cantilever bending and torsion. We found that dorsal plating had the highest peak load to failure. However, initial bending stiffness of the 3.0 mm intramedullary headless compression screw was higher than that of the dorsal plates. In torsion testing, dorsal plating had the highest peak torque, but there was no significant difference in torsional stiffness between the plate and intramedullary headless compression screw constructs. We concluded that intramedullary headless compression screw fixation is biomechanically superior to K-wires in cantilever bending and torsion; however, it is less stable than dorsal plating. In our study, the initial stability provided by K-wire fixation was sufficient to cope with expected loads in the early rehabilitation period, whereas dorsal plates and IHCS constructs provided stability far in excess of what is required.

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

Hand ◽  
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.

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

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.

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

Hand ◽  
2019 ◽  
Vol 15 (6) ◽  
pp. 798-804 ◽  
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.

Headless Compression Screw Fixation of Jones Fractures

2012 ◽  
Vol 40 (11) ◽  
pp. 2578-2582 ◽  
Author(s):  
Masashi Nagao ◽  
Yoshitomo Saita ◽  
So Kameda ◽  
Hiroaki Seto ◽  
Ryo Sadatsuki ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Insertion Site ◽  
Autogenous Bone ◽  
Compression Screw ◽  
Screw Insertion ◽  
Headless Compression Screw ◽  
Full Activity ◽  
Competitive Athletes ◽  
The Mean ◽  
Mean Time

Background: Internal fixation is advocated as the primary treatment for fifth metatarsal Jones fractures in athletes; however, screw insertion site discomfort and refracture can occur especially in competitive athletes. The ideal implant has not been determined. Hypothesis: Headless compression screw fixation of proximal fifth metatarsal Jones fractures is an effective treatment approach especially in competitive athletes. Study Design: Case series; Evidence level, 4. Methods: We studied 60 athletes treated surgically with a headless compression screw for fifth metatarsal Jones fractures (mean age, 19 years). The mean follow-up time was 178 weeks. We evaluated the clinical and radiographic outcomes of headless compression screw fixation of Jones fractures. Results: All athletes returned to full activity. The mean time to start running after surgery was 6.3 weeks (range, 3-12.7 weeks), and the mean time to full activity after surgery was 11.2 weeks (range, 6-25 weeks). One athlete suffered a delayed union, which healed uneventfully. One athlete suffered a nonunion and underwent reoperation for a screw exchange to an autogenous bone graft harvested from the iliac crest. No screw breakage was reported. No athlete suffered a refracture or discomfort in the screw insertion site. Conclusion: Headless compression screw fixation of fifth metatarsal Jones fractures provided excellent results, allowing athletes to return to full activity without both screw insertion site irritation and clinical refracture.

Headless Compression Screw Fixation for Proximal Phalanx Fractures: A Biomechanical Study

Hand ◽  
2020 ◽  
pp. 155894472092664
Author(s):  
Lauren Fader ◽  
Luke Robinson ◽  
Michael Voor
Keyword(s):  
Screw Fixation ◽  
Proximal Phalanx ◽  
Biomechanical Study ◽  
Materials Testing ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Screw Length ◽  
Significant Difference ◽  
Flexion Extension ◽  
Bending Load

Background: Proximal phalanx fractures are common injuries of the hand with multiple treatment options. Intramedullary (IM) screw fixation has become more widely used, and early outcomes are promising. However, biomechanical data regarding this type of fixation are sparse. Methods: Two methods of IM screw fixation of proximal phalanx fractures were tested in cadaver specimens. All specimens were treated with a single antegrade headless compression screw, with half getting the addition of a blocking screw. To test the most common deforming force of flexion-extension, each phalanx was subjected to apex volar 3-point bending using the Materials Testing System test frame. Results: There was no significant difference in the stiffness of 3-point bending with single antegrade screws alone and with a blocking screw (mean, 63.1 vs 52.2 N/mm; P = .27). When comparing smaller with larger specimens, stiffness of the small group was significantly greater than that of the large group when both fixation methods were included (85.3 vs 30.1 N/mm; P < .0002). When comparing stiffness with percent fill of the screw within bone, there was a moderately positive correlation (0.51). Conclusions: Addition of a blocking screw did not increase the stability of the IM screw fixation construct for proximal phalanx fractures. When comparing specimen size, the smaller bones were stiffer under 3-point bending load, regardless of the type of fixation. In addition, those specimens that had a larger longitudinal screw length to bone length ratio were stiffer. These findings provide valuable information as techniques for IM screw fixation of proximal phalanx fractures continue to evolve.

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