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1Principles

Abaxial articular fracture of the distal phalanx - screw fixation

Number and direction of screws

Interfragmentary compression is achieved through insertion of at least one screw placed in lag technique. Ideally, a second screw should be inserted to provide additional compression and rotational stability.

In abaxial articular fractures there is usually not enough space for two 4.5 mm screws. However, it may be possible to insert one 4.5 mm and one 3.5 mm screw or a Kirschner wire.
Insertion of two 3.5 mm screws is another option though less stable.

The screws can be inserted in a dorsopalmar/plantar direction or in a palmaro/plantarodorsal direction (left). However, if an attempt is made to use two interfragmentary screws, they should be inserted in dorsopalmar/plantar direction

Note: Displaced fractures are usually reduced when non-weight bearing.