Abstract: Outcomes of Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws: A Literature Review

Abstract

INTRODUCTION: Metacarpal fractures are a common occurrence in the United States, making up 33.3% of all hand fractures. The majority can be treated nonoperatively, but surgery is indicated when fractures cannot be reduced or fracture alignment cannot be stabilized using closed methods. In 2010, Boulton et al reported intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture. This method has since been described as an operative technique for displaced, comminuted subcapital, and metacarpal neck and shaft fractures. The purpose of this review is to evaluate the recent studies reporting on the outcomes of intramedullary screw fixation of metacarpal fractures. METHODS: Pubmed, Web of Science, and Cochrane were searched. All outcome data from articles reporting on the use of intramedullary screws for the treatment of metacarpal fractures were combined. RESULTS: A total of five articles, one of which was the original case report, were identified for a total of 115 metacarpal fracture repairs performed using intramedullary screw fixation. The majority (84%) were in the small finger with fracture location in the metacarpal neck (69%). All studies used 2.4mm or 3.0mm screws ranging from 32-50mm in length for fixation. Average follow-up was 14 months with an average MCP flexion of 82 degrees (n=78). One study (n=18) did not record MCP flexion, but reported each digit to have a total active motion >240 degrees. All but one study measured radiographic union as an outcome, and all (n=78) resulted in 100% union at or before the latest follow-up. Additionally, grip strength was assessed in two studies (n=29), which showed an average of at least 98% of the contralateral hand. No serious complications were reported. Only one hardware removal was performed due to radiographic suspicion of intra-articular screw penetration. Of note this was a complication of the Y strutting technique in which two intramedullary screws are placed. CONCLUSION: Intramedullary fixation of metacarpal fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option for metacarpal fractures. Advantages of this technique over previously described methods (intramedullary nail or percutaneous K-wire fixation) include no requirement of K-wire removal and increased rotational stability, thus allowing for earlier mobilization.