Intramedullary Compression Screw Fixation of Proximal Phalanx Fractures: An Updated Systematic Review

Proximal phalangeal fractures occur at a higher frequency than other phalanges, but the optimal management of these injuries remains subject to debate. The use of intramedullary screw (IMS) fixation has gained popularity over the last decade and aims to minimize extensor apparatus violation whilst providing adequate construct stability to allow early motion and rehabilitation. This systematic review aims to provide an updated analysis of patient- and clinician-reported outcome measures following fracture fixation using IMS in the proximal phalanx. A literature search was conducted using PubMed, Ovid Medline, Embase, and the Cochrane Controlled Register of Trials, yielding 16 studies with 204 fractures for inclusion. A mean total active motion of 237°, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score of 3.58, and DASH score of 2.65 was revealed by pooled analysis of the included studies. A total complication rate of 6.4% was reported, including screw prominence, fracture displacement, infection, and flexion contracture. This updated systematic review finds good functional outcomes and a low complication rate following the use of IMS fixation for proximal phalangeal fractures.