Accuracy in Screw Selection in a Cadaveric, Small-Bone Fracture Model.

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Surgical Outcomes

Background:

• Proximal phalangeal fractures are common injuries requiring surgical fixation.
• Accurate screw length selection is crucial for successful internal fixation and to avoid complications.

Purpose of the Study:

• To evaluate the impact of surgical training level on screw length selection accuracy for proximal phalangeal fractures.
• To assess the efficacy of depth gauging without fluoroscopy in selecting ideal screw lengths.

Main Methods:

• A cadaveric model simulating open reduction and internal fixation of proximal phalangeal fractures was used.
• Participants of varying training levels measured drill holes and selected screw lengths using a depth gauge.
• Screw selection accuracy (short, long, ideal) was compared across training groups.

Main Results:

• The overall rate of ideal screw selection was 49.2%, lower than anticipated.
• No statistically significant correlation was found between higher training levels and improved ideal screw selection rates.
• Attending surgeons demonstrated a lower tendency for selecting short screws or screws protruding excessively beyond the volar cortex.

Conclusions:

• Reliance solely on depth gauging for screw selection in phalangeal fracture surgery may be insufficient.
• Further research into advanced technologies for precise screw length determination is warranted to improve surgical outcomes.