Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires

Retrograde Intramedullary Pinning of Metacarpal Fractures Through the Collateral Recess

There are several common types of fixations for metacarpal fractures: pins, plates, lag, and intramedullary (IM) screws. The advantages of pins are that they are ubiquitous, cost-effective, have shorter operative times, and preserve soft tissues, thereby minimizing adhesions. In this article, we describe metacarpal fracture fixation utilizing the technique of retrograde IM pinning through collateral recess access. We present the postoperative outcomes of our patients who underwent metacarpal fracture fixation utilizing this technique. Details of the fractures, patient comorbidities, demographics, and postoperative outcomes were gathered. Primary outcomes investigated were nonunion, malunion, need for revision, and range of motion (ROM). A total of 29 fractures in 14 patients were included, with multiple fractures present in 8 patients. The fractures were open in 8 cases. The orientation of the fracture was transverse in 22 cases and oblique in 7 with comminution noted in 13 fractures. Full ROM was obtained in 15 digits with 6 digits noted to have a good ROM and 6 digits still undergoing therapy. There were no nonunions noted and only one malunion. In conclusion, retrograde, double IM pinning through collateral recess access represents a reliable, cost-effective, and minimally traumatic method of metacarpal fixation, including carpometacarpal fracture dislocations.

Postoperative Outcomes Following Metacarpal Neck Fractures Treated With Intramedullary Screws Versus Closed Reduction Percutaneous Pinning

BACKGROUND

Metacarpal neck fractures are frequently encountered by hand surgeons. Certain operative metacarpal neck fractures are amenable to both retrograde intramedullary screw (IMS) fixation and closed reduction percutaneous pinning (CRPP). The purpose of this study was to compare functional outcomes and complications following these two techniques.

METHODS

All patients with metacarpal neck fractures treated with either IMS or CRPP from 2015 to 2021 at a large private academic institution were retrospectively identified. Electronic medical records were reviewed for demographics, Quick Disabilities of Arm, Shoulder, and Hand (qDASH) scores, metacarpophalangeal joint range of motion (ROM), and complications.

RESULTS

A total of 113 patients, consisting of 57 in the IMS cohort and 56 in the CRPP cohort, were included. The CRPP cohort was significantly younger, otherwise demographics were similar between both groups. Both cohorts had similar preoperative (47.5 IMS vs 43.9 CRPP), postoperative (17.6 IMS vs 9.9 CRPP), and delta (35.5 IMS vs 34.0 CRPP) qDASH scores. Retrograde IMS allowed for greater flexion at 4 to 6 weeks (81° vs 65°) postoperatively. The overall incidence of complications was similar among IMS and CRPP (21.1% vs 17.9%), although IMS had significantly more major complications (8.8% vs 0%).

CONCLUSIONS

Despite earlier return to ROM, operative fixation of unstable metacarpal neck fractures with retrograde IMS may be at higher risk of major hardware complications and extensor lag.

Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review

PURPOSE

There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures.

METHODS

A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data.

RESULTS

Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery.

CONCLUSIONS

Complications following IMS fixation of metacarpal fractures are relatively uncommon.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.