![]() Two forces that need to be adequately addressed are bending and torsional forces during MCP or PIP joint flexion. 12 Initially, the majority of load and anatomic alignment across fracture is supported by the screw, but as the fracture heals, the load is transferred to the bone. IMF biomechanical properties are well described in orthopedic literature as load-sharing devices. 11 The purpose of this study was to review intermedullary screw fixation of metacarpal and phalanx fractures while summarizing the pearls and pitfalls to maximize successful surgical outcomes. Pinal et al demonstrate complete fracture healing in 69 patients, mean total active motion of 247 degrees and full return to activity at an average of 76 days. Due to the minimally invasive nature of this technique, patients experience better outcomes in terms of range of motion, earlier return to work, and minimal complications. IMF is a fixation option that offers rigid stability, early active range of motion, and simplicity of insertion. The goal of reconstruction is to provide rigid fixation that can support early range of motion. Intramedullary screw fixation (IMF) is an emerging alternative to K-wire or plate fixation in treating displaced and unstable phalangeal and metacarpal fractures. These options have drawbacks of malunion, nonunion, infection, need for hardware removal, and stiffness. 5, 6 There are minimally invasive techniques, including the use of K-wires, lag screws, cerclage wiring, and external fixation that limit soft tissue dissection. 5– 7 Reported complications requiring surgical intervention include stiffness, proximal interphalangeal joint fixed flexion contracture, and extensor lag. ![]() Plate fixation is able to provide reduction and stability for early range of motion with mixed clinical results. ![]() 1– 4 For fractures of the proximal phalanx and metacarpal, no method of fixation has been determined to be superior to another. Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures after fractures of the distal radius. ![]()
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