Clinical outcomes of percutaneous intramedullary headless screw fixation with an oblique technique for the treatment of proximal and middle phalanx fractures.

Background: Intramedullary headless screw fixation has become significant in the treatment of phalangeal fractures. While intramedullary headless screw fixation is a simple and rigid approach, common techniques for guide wire insertion, including retrograde, antegrade-intra-articular, and trans-articular techniques, damage the articular cartilage and extensor tendon, particularly the central slip. To mitigate these risks, we applied a new method by percutaneously inserting the screw obliquely from the radial or ulnar base of the proximal or middle phalanges. This study aimed to assess the clinical outcomes of intramedullary headless screw fixation using the oblique technique in the treatment of proximal and middle phalangeal fractures.

Methods: Between April 2022 and August 2023, we retrospectively collected data on consecutive unstable proximal or middle phalangeal fractures treated with percutaneous intramedullary headless screw fixation using the oblique technique. The clinical outcomes were the active range of motion of each phalangeal joint and the grip strength ratio. Surgical time, fracture union, and complications were also evaluated.

Results: Sixteen patients (6 middle and 10 proximal phalanx fractures) were included in this study. The mean operative time was 34.2 min, while the median fracture union time was 7.2 weeks. The mean values of the active range of motion (ROM) of extension and flexion of the proximal interphalangeal joint were -1.3° and 98.5°, respectively, in middle phalanx fractures and -9.2° and 83.7° in proximal phalanx fractures. No complications were observed.

Conclusions: This study demonstrated the good clinical outcome of percutaneous intramedullary headless screw fixation using the oblique technique for proximal and middle phalangeal fractures. This simple technique reduces the damage risk to the articular cartilage and extensor tendons.