“Intramedullary Screw Fixation of Metacarpal Fractures Results in Excellent Functional Outcomes: A Literature Review”

Background: Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to identify and evaluate all studies reporting clinical outcomes of intramedullary screw fixation of metacarpal fractures. Methods: A comprehensive search of the literature was performed under PRISMA guidelines to identify all relevant studies. Variables included patient and fracture characteristics, surgical approach, and rehabilitation practices. Outcome measures included mean follow-up, complications, evidence of radiographic union, functional outcomes, and quality of life measures. Results: Nine articles for a total of 169 metacarpal fractures were identified. Average patient age was 32 years and predominantly male (86.5%) with the majority of fractures occurring in the small finger (74%). Most fractures occurred in the neck (n=66), followed by shaft (n=31), and head (n=10). The average follow-up was 11 months with an average metacarpophalangeal joint flexion of 86°(n=83) and digit total active motion of 251° (n=72). All but one study measured radiographic union, and all (n=132) resulted in 100% union at or before the latest follow-up. Grip strength was assessed in four studies, which showed an average of 96% of the contralateral hand. No serious complications were reported. Nine minor complications were reported including four cases of hardware removal in asymptomatic patients. Conclusion: The review of the literature suggests intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option resulting in excellent clinical outcomes. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: Plastic Surgery the Meeting (ASPS) October 8, 2017 in Orlando, FL Corresponding Author: Christina M. Beck, PhD, Icahn School of Medicine at Mount Sinai, 50 East 98th Street , New York, NY, 10029, USA. Christina.beck@icahn.mssm.edu ©2019American Society of Plastic Surgeons

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