Clinical Outcomes of Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures

Purpose To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures. Methods Retrospective review of prospectively collected data on a consecutive series of 39 patients (34 men; 5 women), mean age 28 years (range, 16-66 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N = 26) and shaft (N = 13) fractures at a single academic practice between 2010 and 2014. Preoperative magnitude of metacarpal neck angulation averaged 54 degrees (range, 15 degrees to 70 degrees), and shaft angulation averaged 38 degrees (range, 0 degrees to 55 degrees). Patients used a hand-based orthosis until suture removal and began active motion within the first week. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis was assessed. Twenty patients reached minimum 3-month follow-up, with a mean of 13 months (range, 3-33 mo). Results All 20 patients with minimum 3 months of follow-up achieved full composite flexion, and extensor lag resolved by 3-week follow-up. All patients demonstrated full active metacarpophalangeal joint extension or hyperextension. Grip strength measured 105% (range, 58% to 230%) of the contralateral hand. No secondary surgeries were performed. There were 2 cases of shaft re-fracture from blunt trauma following prior evidence of full osseous union with the screw in place. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported occasional clicking with metacarpophalangeal joint motion not requiring further treatment. Conclusions Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages in select patients. (Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.)