Screw fixation for certain fractures of the phalanges and metacarpals.

Twenty-one patients with fractures of the bones of the hand were treated by open reduction and internal fixation with compression screws. The firm fixation allowed range-of-motion exercises in most patients to be begun on the third postoperative day. On follow-up mild restriction in digital motion was seen in only one patient, and significant disturbance in joint function was not encountered. In spite of these advantages, the method is indicated in only a small percentage of such fractures. Usually traditional methods of open reduction and internal fixation are preferred when an open procedure is needed. However, oblique and spiral fractures of the proximal phalanx, some fractures with large single articular fragments particularly involving the proximal interphalangeal joint, and appropriate Bennett's fractures are suitable for screw fixation.