Complications of intramedullary screw fixation in proximal phalanx fractures: a systematic review

The use of intramedullary screw fixation for proximal phalanx fractures has gained popularity recently due to its ability to provide rigid fracture fixation whilst allowing early mobilization and rehabilitation. However, few reviews explored the complications of this surgical method on proximal phalanx fractures despite an increasing number of clinical series. This review aims at providing an updated analysis on the complications of intramedullary screw fixation on proximal phalanx fractures.

A systematic literature search was performed using PubMed, Ovid MEDLINE, Embase, and Cochrane Controlled Register of Trials. All primary research studies were identified and screened in accordance with the PRISMA guidelines. Complications were reported qualitatively and were analyzed using descriptive statistics and an exploratory meta-analysis of proportions.

12 studies were included in the systematic review among 657 studies identified from database search. A total of 301 proximal phalanx fractures were included, with an overall mean follow-up period of 90.1 weeks. The overall complication rate of 10.0 % (30/301; 95 % CI: 6.6 %-13.4 %). The most common complication was delayed union (n = 8), followed by loss of reduction (n = 6), and screw impingement, discomfort or pain (n = 6). 18 patients received revision surgery, yielding a revision surgery rate of 6.0 % (18/301; 95 % CI: 3.3 %-8.7 %). Most revision surgeries (15 out of 18) involved screw removal. 2 cases underwent revision fixation and 3 cases received splintage for extension lag.

While intramedullary screw fixation offers stable fixation for early mobilization of proximal phalangeal fractures, surgeons need to be aware of the common complications associated with the procedure.