Antegrade Intramedullary Screw Fixation: A Novel Approach to Metacarpal Fractures

Abstract

Metacarpal fractures are common upper-extremity fractures. Surgical fixation is recommended for open injuries, segmental bone loss, multiple metacarpal fractures, irreducible fractures, and unstable fracture patterns. For transverse and short oblique metacarpal shaft fracture patterns, intramedullary headless compression screws have been added most recently as a surgical option. Intramedullary headless compression screw fixation has been performed in a retrograde manner in which a guidewire and then a cannulated headless screw are placed through a skin excision, a split in the sagittal band or extensor tendon, and the dorsal central articular cartilage surface of the metacarpal head. Here, we describe a step-by-step novel approach to fixation of transverse and short oblique proximal and midshaft metacarpal fractures through an antegrade approach using intramedullary headless compression screws with a detailed 4K high-definition video demonstration and 2 clinical cases involving the middle and ring metacarpals. This surgical alternative addresses many concerns with the retrograde technique and avoids creating defects in the extensor tendon, the sagittal hood, the articular surface of the metacarpal head at the metacarpophalangeal joint, and the articulating surface of the trapezium, capitate, and hamate at the carpometacarpal articulation.