Intramedullary Headless Screw Fixation for Metacarpal Fractures

Abstract

Multiple techniques have been proposed for metacarpal fracture fixation, including percutaneous Kirschner-wires, interfragmentary screws, plate and screw constructs, intramedullary (IM) nails, and cannulated IM headless screws. Each of these treatment options has its proposed advantages and disadvantages, and there remains no consensus on the optimal mode of treatment. We describe a technique of retrograde IM headless screw fixation for extra-articular metacarpal fractures.

Headless Compression Screw for Metacarpal Nonunion: Description of a New Technique and Report of 4 Cases

“…Other recent studies also favor intramedullary fixation of metacarpal fractures, corroborating previous evidence of efficacy. [20][21][22][23][24] The use of autologous bone grafting is still indicated for the treatment of nonunions. Unstructured cancellous bone grafting leads to adequate healing stimuli in the hand.…”

Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature

“…12 This technique also works well in the setting of a phalangeal nonunion (Figs. [1][2][3][4][5][6][7][8][9][10][11][12][13]. 13 Contraindications include those involving open physes, length unstable (long oblique or very comminuted) fractures or those with significant bone loss, active infection, and complex intra-articular fractures patterns.…”

“…The retrograde technique is well described in metacarpal fractures and less so in proximal phalanx fractures. 6,7,9,14 The steps are analogous to those described here for the antegrade technique, except for a few considerations. When violating the PIPJ, it is important to monitor the integrity of the central slip during exposure and hardware insertion, and it is prudent to insert the guidewire using an oscillatory function and insert the screw by hand (Figs.…”

“…There are a multitude of techniques described, including percutaneous Kirschner wire fixation, open reduction and internal fixation with interfragmentary screws or plate-screw constructs, and cannulated intramedullary headless screws 4,5. Surgical techniques and patient outcomes using intramedullary headless screw have been described with good early and mid-term results for phalangeal and metacarpal fractures 6–9. In this article, we present our surgical technique for intramedullary headless screw fixation in the proximal and middle phalanx and review the current outcomes literature using this technique.…”

“…4,5 Surgical techniques and patient outcomes using intramedullary headless screw have been described with good early and mid-term results for phalangeal and metacarpal fractures. [6][7][8][9] In this article, we present our surgical technique for intramedullary headless screw fixation in the proximal and middle phalanx and review the current outcomes literature using this technique.…”