OTA 2004 Posters
Locked Percutaneous Intramedullary Nailing of Metacarpal and Phalangeal Fractures
Purpose: Extraarticular fractures of the long bones of the hand are common, but consensus on the best mode of treatment has not been established. Open treatment with plates or screws is frequently followed by extensor tendon adhesions or unsightly scars or both. Flexible intramedullary nailing is a proven minimally invasive technique that provides limited stability. We introduced a new method of locking these miniature hand nails to enhance fixation and expand their indications.
Methods: Extraarticular metacarpal and phalangeal fractures, including those with spiral patterns or segmental comminution, were treated with close fluoroscopically assisted reduction and locked percutaneous flexible nails. A manually operated slotted awl was used for nail insertion, and proximal locking was provided by a captured transverse pin. The nails were routinely removed after fracture healing. Standard principles of hand rehabilitation, including early motion and splinting, were used in the postoperative period.
Results: We retrospectively reviewed the records of 84 consecutive patients treated at our center with this technique between July 1999 and June 2000. We were able to observe 73 patients for a minimum of one year. There were 45 metacarpal and 28 phalangeal fractures. All fractures healed. There were no rotational deformities or significant shortening. Patients with metacarpal fractures generally recovered full range of motion. Average total active motion for phalangeal fractures was 240. Loss of proximal interphalangeal joint extension with proximal phalanx fractures averaged 15°. Complications consisted of delayed healing (> 8 weeks) because of distraction in one metacarpal and one phalangeal fracture and two cases of tendon irritation over the base of the 4th metacarpal.
Conclusion and Significance: This minimally invasive technique avoids exposure of the fracture, dissection around the extensor mechanism, and scar problems. We obtained excellent functional results and a low complication rate. Locking the nails controls length and rotation. Phalangeal fractures present a more serious challenge.