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Minimally Invasive Intraosseous Fracture Fixation: A Novel Approach for Fixation in Hand Fractures
Pooja Humar, BS; Baris Fuat Bengur, MD; Jacob Thayer, MD; Michael Hu, MD, MPH, Yadira Villalvazo, MD; Jignesh Unadkat, MD
University of Pittsburgh Medical Center
2023-01-31
Presenter: Pooja Humar
Affidavit:
All work on this project represents the original work of the include authors
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Current standards of hand fracture management often result in prolonged immobilization, causing 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.
Methods: We conducted a retrospective review of patients who underwent IM screw placement for fixation of hand fractures (metacarpals and phalanges), by a single surgeon from 2020-2022. Patient demographics; fracture type and location; post-operative complications; and outpatient discharge data was collected.
Results: There were 72 patients with 95 fractures (56 metacarpals, 39 phalanges). 80.8% of patients presented with a single fracture, 16.0% had 2, and 3.2% had 3 or more fractures. 31 fractures had other concurrent procedures. Median operative time was 56 minutes (IQR, 5-72 min) and tourniquet time was 31 minutes (IQR, 5-48 min). 33 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.
Conclusions: 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.
