{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:21:14Z","timestamp":1788186074506,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Intramedullary headless compression screw (IMHCS) fixation has emerged as a minimally invasive and biomechanically robust method for treating metacarpal and proximal phalangeal fractures. While the clinical outcomes are generally favorable, the impact of anatomical fracture reduction on postoperative function has not been systematically examined. Methods: We retrospectively analyzed 69 patients (41 metacarpal, 28 proximal phalanx) treated with IMHCSs between June 2020 and March 2025. Fractures were classified radiographically as reduced or non-reduced. Functional outcomes were assessed using the Total Active Motion (TAM) scoring system. The association between the reduction quality and TAM outcome was analyzed separately for metacarpal and proximal phalangeal fractures using the Fisher\u2013Freeman\u2013Halton exact test. Results: All fractures achieved radiographic union. In the metacarpal fractures, 90% of the patients attained good-to-excellent TAM scores, with no statistically significant association between the reduction quality and functional outcome (p = 0.1303). In contrast, for the proximal phalangeal fractures, anatomical reduction was significantly associated with superior TAM outcomes (p = 0.0014; Cohen\u2019s w = 0.802). The postoperative radiographs in this group revealed smooth dorsal cortical alignment in the patients with good outcomes, suggesting preserved tendon gliding surfaces. Conclusions: Anatomical fracture reduction significantly predicts postoperative function in proximal phalangeal fractures treated with IMHCSs. In contrast, metacarpal fractures appear more tolerant of minor malalignment. These findings underscore the importance of achieving cortical continuity in phalangeal fractures to optimize digital biomechanics. A minimal open approach should be considered to ensure proper alignment during IMHCS fixation.<\/jats:p>","DOI":"10.3390\/jcm14134691","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T04:07:17Z","timestamp":1751515637000},"page":"4691","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dorsal Cortical Alignment Predicts Functional Outcomes in Proximal Phalangeal Fractures Treated with Intramedullary Headless Compression Screws but Not in Metacarpal Fractures"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0157-3316","authenticated-orcid":false,"given":"Bert","family":"Vanmierlo","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, AZ Delta, Deltalaan 1, 8800 Roeselare, Belgium"},{"name":"Department of Cardio and Organ Systems, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Lowyck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, AZ Delta, Deltalaan 1, 8800 Roeselare, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Matthys","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KU Leuven, Campus Gasthuisberg ON2, Herestraat 49\u2013Bus 400, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2912-0578","authenticated-orcid":false,"given":"Tim","family":"Vanmierlo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Biomedical Research Institute (Biomed) Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium"},{"name":"Division of Translational Neuroscience, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-6023","authenticated-orcid":false,"given":"Joris","family":"Duerinckx","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium"},{"name":"Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert O.","family":"Eijnde","sequence":"additional","affiliation":[{"name":"SMRC-Sports Medical Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium"},{"name":"Division of Sport Science, Faculty of Medicine & Health Sciences, Stellenbosch University, Cnr. 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