Minimally Invasive Intramedullary Screw Versus Plate Fixation for Proximal Phalanx Fractures: A Biomechanical Study

Megan R. Miles, Kevin P. Krul, Pooyan Abbasi, Madhuli Y. Thakkar, Aviram M. Giladi, Kenneth R. Means

Research output: Contribution to journalArticlepeer-review


Purpose: To compare the maximum interfragmentary displacement of short oblique proximal phalanx (P1) fractures fixed with an intramedullary headless compression screw (IMHCS) versus a plate-and-screws construct in a cadaveric model that generates finger motion via the flexor and extensor tendons of the fingers. Methods: We created a 30° oblique cut in 24 P1s of the index, middle, ring, and little fingers for 3 matched pairs of cadaveric hands. Twelve fractures were stabilized with an IMHCS using an antegrade, dorsal articular margin technique at the P1 base. The 12 matched-pair P1 fractures were stabilized with a radially placed 2.0-mm plate with 2 bicortical nonlocking screws on each side of the fracture. Hands were mounted to a frame allowing a computer-controlled, motor-driven, linear actuator powered movement of fingers via the flexor and extensor tendons. All fingers underwent 2,000 full-flexion and extension cycles. Maximum interfragmentary displacement was continuously measured using a differential variable reluctance transducer. Results: The observed mean displacement differences between IMHCS and plate-and-screws fixation was not statistically significant throughout all time points during the 2,000 cycles. A 2 one-sided test procedure for paired samples confirmed statistical equivalence in fracture displacement between fixation methods at the final 2,000-cycle time point. Conclusions: The IMHCS provided biomechanical stability equivalent to plate-and-screws for short oblique P1 fractures at the 2,000-cycle mark in this cadaveric model. Clinical relevance: Short oblique P1 fracture fixation with an IMHCS may provide adequate stability to withstand immediate postoperative active range of motion therapy.

Original languageEnglish (US)
Pages (from-to)518.e1-518.e8
JournalJournal of Hand Surgery
Issue number6
StatePublished - Jun 2021
Externally publishedYes


  • Headless compression screw
  • internal fixation
  • intramedullary
  • plate fixation
  • proximal phalanx fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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