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Updated: Jun 16, 2026

A Passive Ankle Dorsiflexion Testing System for an In Vivo Model of Overuse-induced Tendinopathy
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Quantifying Extensor Tendon and Articular Surface Involvement During Phalangeal Intramedullary Fixation.

Julie Mekhail1, Rhiana Rivas2, Nikalus Skipp3

  • 1Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL.

Journal of Hand Surgery Global Online
|June 15, 2026
PubMed
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Intramedullary (IM) hand nail fixation for phalangeal fractures impacts extensor tendons by ~9% and articular cartilage by ~5%. Larger 3.5-mm nails caused greater cartilage involvement than 3.0-mm nails.

Area of Science:

  • Orthopedic surgery
  • Hand surgery
  • Biomedical engineering

Background:

  • Phalangeal hand fractures are common upper-extremity injuries.
  • Intramedullary (IM) hand nail fixation is increasingly used for these fractures.
  • Implant insertion requires penetration of articular cartilage.

Purpose of the Study:

  • To quantify cartilage involvement from anterograde and retrograde IM fixation.
  • To compare fixation with 3.0-mm and 3.5-mm IM threaded hand nails.
  • To assess involvement in proximal and middle phalangeal fractures.

Main Methods:

  • Fifty fresh-frozen fingers from 10 cadaveric hands were used.
  • Anterograde fixation into the middle phalanx and retrograde fixation into the proximal phalanx were performed.
Keywords:
ArticularFixationFractureIntramedullaryPhalanges

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  • ImageJ software quantified extensor tendon and articular surface involvement from clinical photographs and fluoroscopy.

    • Main Results:

    • Mean extensor tendon involvement was <9% (7.8%–10.1%).
    • Average articular cartilage defect was <5% (4.3%–5.9%).
    • The 3.5-mm implants resulted in greater articular surface area involvement than the 3.0-mm implants.

    Conclusions:

    • IM fixation impacts extensor tendons and articular surfaces by approximately 9% and 5%, respectively.
    • This technique may be viable for treating middle phalanx fractures.
    • Careful consideration of implant size is warranted to minimize cartilage damage.