Intramedullary Cannulated Compression Screws for Extra-Articular Phalangeal Fractures

Background: There is no consensus as to which is the best way to fix unstable extra-articular phalangeal fractures. We performed a literature review to determine outcomes using intramedullary cannulated compression screws. Methods: PubMed, Medline and Embase databases were searched for English language articles reporting the use of one or more intramedullary screw(s) for fixation of an acute extra-articular phalangeal fracture in adults that reported outcome data. Results: A total of 62 abstracts were identified, of which 14 full-text articles were eligible for full-text screening for the inclusion criteria. Of these 14 articles, seven articles were included in the final study. Data on 146 phalangeal fractures were aggregated with an average patient age of 36 (18-84). 89% (130/146) fractures were of the proximal phalanx, the remainder of the middle phalanx. Surgical technique was mostly a minimally invasive technique under fluoroscopy guidance using an anterograde technique. One paper described a retrograde method. Screw diameter varied from 2.2 mm to 3.2 mm. Where the radiographic union was reported, all fractures united. Range of motion averaged 231° (range 95°-295°) in four studies. Return to work was reported as 6.4 weeks (range 0.9-16.7 weeks) in one study. Different quality-of-life scores were reported by the studies (DASH 3.52 (range 1-45), QuickDASH score of 3.9 and DASH score of 3.9). Complications rate was 5% (8/146) including 5 major complications and 3 minor in the pooled results. Conclusions: This literature review demonstrates that fixation of extra-articular fractures of the proximal and middle phalanges with cannulated compression screws is a safe and successful surgical treatment with faster mobilization and return to work with fewer complications, including stiffness, than have been reported with plates and screws and percutaneous K-wires. This application is limited to transverse and short oblique extra-articular fractures.