遷延治癒を起こした第4足趾末節骨-中節骨癒合骨骨折に対してvariable pitch headless compression screwを用いて手術した1例

Osteosynthesis with a Variable Pitch Headless Compression Screw for an Interphalangeal Coalition Fracture of the Fourth Toe. Case Report

　第4足趾末節骨-中節骨癒合骨骨折に対してvariable pitch headless compression screwを用いて手術した1例を報告する．患者は42歳の女性で，歩行中，誤って柱に右第4足趾をぶつけて受傷し，同日初診した．初診時単純X線像では第4足趾の末節骨と中節骨の癒合骨に横走する骨折線を認めた．当初，保存的に治療したが，骨折部の転位が徐々に増大して疼痛も持続したため，受傷後15週で手術した．手術は趾間ブロック後に趾尖部からAcutrak 2^® micro screwを挿入した．術後2カ月で骨癒合し，術後1年の現在，圧痛，歩行時痛とも消失している．

　We report a case in which osteosynthesis with a variable pitch headless compression screw was performed to treat an interphalangeal coalition fracture of the 4th toe.　A 42-year-old female struck her right 4th toe against a pole while walking and immediately came to our hospital.　An X-ray examination revealed that the distal phalanx and middle phalanx of her right 4th toe were united and that the interphalangeal coalition had been fractured.　We initially treated the fracture conservatively, however because the fragment gradually became displaced and the pain persisted, 15 weeks after the injury we operated it with an Acutrak 2^® micro headless compression screw.　Bone union was complete by 2 months postoperatively, and the patient has no complains in regard to her daily activities.　Variable pitch headless compression screws apply compression force at the fracture site, the characteristic that promotes bone union, however they are too large to use for fixation of the distal phalanx of a toe.　In our patient, the length of the fractured bone increased for coalition, that enabled us to use a variable pitch headless compression screw.