SRS138 - Crossed cannulated screws for phalangeal fractures: a novel fixation technique

Abstract Introduction Unstable phalangeal fractures require fixation that balances stability with early mobilisation. K-wires, though common, provide only relative stability, necessitate immobilisation, and are linked to infection and stiffness. Cannulated screws offer improved outcomes, yet standard configurations may lack rotational control and optimal load distribution. We present the first UK case series of cross-configuration headless cannulated screws, designed to deliver absolute stability, enhance biomechanics, and enable early recovery. Methods Ten adults with unstable, displaced proximal phalanx fractures were treated using 1.3–1.7 mm headless cannulated screws in a novel cross-configuration. Inclusion criteria were closed fractures requiring fixation. A dorsal or lateral approach was chosen per fracture site. Temporary K-wires secured reduction and guided screw trajectories before removal. All cases were performed under tourniquet. Immediate mobilisation and hand therapy were encouraged. Outcomes included range of motion (ROM), pain, return to activities, compliance, and complications. Results Ten patients (6 male, 4 female; mean age 42.8 ± 17.6 years) underwent fixation for transverse P1 fractures of the non-dominant hand. Mean time from injury to surgery was 14.0 ± 12.4 days. At 6 weeks, mean TAM was 205° (AROM 215°), with a mean PIP lag of 10°. Patients achieved early functional recovery, regaining dexterity for typing, grip, and light daily activities. Pain was minimal and did not restrict rehabilitation. Mild stiffness and occasional scissoring were observed but did not limit overall outcome. Conclusions Cross-configuration screw fixation provides stable outcomes, enabling early mobilisation, primary healing, and low complications. These findings suggest advantages over traditional fixation.