Retrograde intramedullary headless compression screw fixation for pediatric mid-diaphyseal proximal phalanx malunion: A case study

Abstract

Introduction: Proximal phalanx fractures in children, especially mid-diaphyseal fractures, can result in malunion and significant functional impairment. Early malunions require prompt and effective intervention to prevent long-term complications. This case study highlights the use of intramedullary headless compression screw (IMHCS) fixation in addressing a proximal phalanx malunion. Case presentation: A 12-year-old boy presented with a malunion of the mid-diaphyseal proximal phalanx of the fourth finger following conservative treatment of a cycling injury. Initial management involved immobilization followed by buddy taping; however, incomplete radiographic evaluation resulted in an underestimation of the volar angulation. At the four-week follow-up, the patient exhibited 50 degrees volar angulation, clinodactyly, and marked stiffness. The malunion was treated surgically with retrograde IMHCS fixation after osteoclasis. Radiographic evaluation confirmed proper reduction and alignment. The patient began physical therapy immediately, achieved full range of motion within four weeks and maintained excellent functional outcomes at one year postoperatively. Discussion: Retrograde IMHCS fixation is an innovative technique for managing phalangeal malunions, providing stable fixation and enabling early mobilization. This method avoids the physis, minimizing the risk of growth disturbances, eliminates the need for hardware removal, and ensures proper alignment. Conclusion: IMHCS fixation is a promising solution for early malunions and potentially fresh fractures of the proximal phalanx in pediatric patients. It offers stable fixation, preserves physeal integrity, and supports early rehabilitation, contributing to excellent functional recovery. Further studies are needed to evaluate its long-term outcomes.