What question did this study set out to answer?

This study aims to evaluate the efficacy of minimally invasive fixation techniques for proximal phalangeal fractures.

April 30, 2026Open Access

Minimally Invasive Antegrade Fixation of Proximal Phalangeal Fractures with Intramedullary Cannulated Compressive Screws

Key Points

This study aims to evaluate the efficacy of minimally invasive fixation techniques for proximal phalangeal fractures.
Retrospective case series of 18 closed proximal phalangeal fractures in 16 patients.
Patients underwent intramedullary headless screw fixation from January 2018 to December 2023.
Records included demographics, fracture characteristics, and screw type used.
All fractures healed within acceptable radiological parameters.
No postoperative complications were reported.
Mean Total Active Motion was 216.0° (SD 7.7°).
Mean QuickDASH score was 10.1 (SD 2.8).

Abstract

Background/Objectives: Proximal phalangeal fractures account for 38% of all phalangeal fractures, with unstable patterns requiring surgical intervention. Various modalities have been explored, including open reduction and internal fixation, percutaneous K-wire fixation, and intramedullary techniques. This study explores the technical nuances, indication, and outcomes of antegrade cannulated compressive screw (CCS) fixation of proximal phalangeal fractures. Methods: This retrospective case series involved 18 closed proximal phalangeal fractures in 16 patients who underwent intramedullary headless screw fixation between January 2018 and December 2023. Records were reviewed for demographics, fracture characteristics, and screw type. With the metacarpophalangeal joint flexed at 60–75°, a 1 cm longitudinal incision was made, the extensor tendon split, and a 0.9 mm guidewire advanced anterogradely along the phalangeal axis under fluoroscopy. A 2.2 mm or 3.0 mm SpeedTip CCS was selected based on phalanx size and advanced until fully buried below the cartilage line. Postoperatively, patients were immobilized in a volar intrinsic-plus splint, transitioned to a gutter splint within five to seven days, and commenced on range of motion (ROM) exercises within one week. Primary outcomes included radiographic union, Total Active Motion (TAM), QuickDASH scores, and postoperative complications. Results: All fractures were healed within acceptable radiological parameters and with no postoperative complications. Mean TAM was measured to be 216.0° (SD 7.7°, range 200–230°) and mean QuickDASH was 10.1 (SD 2.8, range 5–16). Conclusions: Antegrade intramedullary headless screw fixation demonstrates feasibility, short-term safety, and excellent early functional outcomes for carefully selected unstable proximal phalanx fractures, supporting its role as a minimally invasive alternative in appropriately indicated cases.

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