Fixation of hand fractures with bicortical screws

Traditionally a compression lag screw technique has been described when screw fixation alone is used to fix phalangeal or metacarpal fractures. The purpose of this retrospective case review was to determine whether there is any disadvantage to using a bicortical screw technique instead of the compression screw technique.

Thirty-seven fractures of the phalanges and metacarpals in 36 patients had open reduction and internal fixation. Fixation was achieved with minifragment, self-tapping screws only, which were applied with bicortical fixation rather than a lag technique. Data were obtained through medical record and radiographic review. Intraoperative and immediate postoperative x-rays were compared with final x-rays. Fracture healing, confirmed radiographically, was used to determine whether the bicortical screw technique was adequate for fixation.

All fractures healed by an average of 7 weeks (range, 4-10 wk) without loss of fixation or malunion.

Based on this experience we believe bicortical fixation is a straightforward technique and provides adequate fracture stability and healing.