Early Return of Motion in Patients with Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation
Pooja Humar*, Fuat Baris Bengur, Jacob Thayer, Michael Hu, Yadira Villalvazo, Jignesh Unadkat
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Hand fractures are associated with significant morbidity, affecting activities of daily living, and leading to loss of workdays. Current standards of management often result in prolonged immobilization, resulting in stiffness and delayed return to functional use. In this study, we describe outcomes following intraosseous fracture fixation using intramedullary (IM) cannulated headless screws for a multitude of fracture patterns.
This study is a retrospective review of patients who underwent IM screw placement for fixation of hand fractures (metacarpals and phalanges) at a single institution from 2020-2022. Data was collected to include patient demographics, fracture type, pattern and location, post-operative complications. Outpatient data was used to determine time to range of motion and time to unrestricted motion
There were 72 patients with 95 fractures (56 metacarpals, 39 phalanges). Mean age was 43yrs ± 9.8yrs with 80.6% males. 88% of patients presented with a single fracture while the remainder had two or more fractures. 27 fractures had other concurrent procedures, polytrauma being the most common reason for this. The small finger (36.0%) was the most affected digit. The median time from injury to surgery was 9 days (IQR, 5-14 days). Median operative time was 56 minutes (IQR, 5-72 min) and tourniquet time was 31 minutes (IQR, 5-48 min). 37 patients were allowed controlled motion from the first post-operative day. Average time to allow range of motion from surgery was 8.3 days (IQR 0-32 days) with 31.9 days (IQR 10-62 days) for unrestricted use of hand. There were no post-operative infections. There was 1 hardware removal due to technical failure. 12 patients had work-related hand fracture, of which 11 returned to work at an average of 55.36 days following surgery.
Our findings indicate that the use of IM screw for fixation of hand fractures provides strong, rigid fixation for a wide variety of fracture patterns with a low rate of complications. This technique allows earlier return to work and functional use.
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