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

Fully Threaded Versus Partially Threaded Intramedullary Headless Compression Screw Fixation for Proximal Third Fractures of the Proximal Phalanx: A Biomechanical Study

PURPOSE

The purpose of this study was to compare the maximal elastic force and deformation resistance of two commonly used headless compression screw systems, a fully threaded 2.5 mm screw and a partially threaded screw of the same dimensions, in a cadaveric model of a human transverse proximal third fracture of the proximal phalanx.

METHODS

Six fresh frozen cadavers were used, and the proximal phalanges of the index, long, and ring fingers of both hands were dissected. A proximal third transverse osteotomy was created, and screws were inserted in an antegrade direction. The three-point bending load-to-failure test measured the maximal elastic force and deformation resistance of each bone-screw construct.

RESULTS

The fully threaded screw demonstrated a maximal elastic force of 121 N and a deformation resistance of 134 N/mm. The partially threaded screw showed superior performance with a maximal elastic force of 165 N and deformation resistance of 166 N/mm. The bone-screw construct with the fully threaded screw had a mean maximal elastic force of 155.2 N compared to 101.8 N in the construct with the partially threaded screw. Deformation resistance was 145.2 N/mm for fully threaded screws and 98.6 N/mm for partially threaded screws.

CONCLUSIONS

Fully threaded intramedullary headless compression screw fixation provides superior maximal elastic force and deformation resistance compared to partially threaded intramedullary headless compression screw fixation in transverse proximal third fractures of the proximal phalanx.

CLINICAL RELEVANCE

The findings indicate that fully threaded intramedullary headless compression screw fixation may offer enhanced stability for treating proximal third fractures of the proximal phalanx, potentially leading to better patient outcomes through earlier mobilization and reduced complications compared to partially threaded screws.

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.

Cost Comparison of Intramedullary Screw Fixation Versus Open Reduction and Internal Fixation With Plate and Screw Technique for Metacarpal Fractures

BACKGROUND

Intramedullary screw (IMS) fixation for metacarpal fractures is a relatively new fixation technique in comparison to plate and screw constructs. Our hypothesis evaluated whether IMS fixation for metacarpal fractures results in lower overall health care-associated costs in comparison to open reduction and internal fixation (ORIF).

METHODS

A retrospective review of patients undergoing IMS fixation for metacarpal fractures at a single center during 2018 to 2022 was conducted. Health care-associated costs included primary operative costs (surgical time and implant(s)) and postoperative costs (therapy, splinting, and radiology). Costs were compared with age-matched and fracture pattern-matched controls who underwent ORIF with plate and screw construct. Subgroup analysis of cost outcomes excluding outliers was completed.

RESULTS

Eight subjects met the inclusion criteria and matched with an ORIF group. Primary operative costs were significantly higher in the ORIF group (mean difference of $1830, 95% CI: $1006 to $2653) The cost of an IMS at our institution was $584, whereas the average cost for plate and screw construct was $2538 (mean difference of $1953, 95% CI: $1665 to $2243). Total surgical costs were on average $3784 more for the ORIF group (95% CI: $2869 to $4700). There was no significant difference in outpatient follow-up costs (95% CI: -$441 to $3180). Total overall costs were significantly lower for the IMS group (95% CI: $2693 to $6513).

CONCLUSIONS

Total primary operative costs and overall health care-associated costs for IMS fixation of metacarpal fractures is significantly lower than ORIF. There was no statistical difference in follow-up care costs. To better determine the indirect costs for patients, high-powered prospective studies will be required.

Metacarpal Fracture Fixation with Intramedullary Screws

Background: Intramedullary screws (IMS) have become a viable option for metacarpal fracture fixation. To further appraise their utility, this study assessed clinical and patient-reported short- and medium-term outcomes of IMS fixation for extra-articular metacarpal fractures. Methods: A retrospective cohort study was performed in a series of 32 patients (with a total of 37 fractures) who underwent metacarpal fracture fixation over a 42-month period between January 2020 and July 2023. Results: Mean time for return to work was 39.8 days; mean time for return to full function was 88.4 days; total active motion was 250.7° (range: 204.9-270.9); Quick Disabilities of the Arm, Shoulder and Hand score was 2.3 (range: 0-22.7); mean visual analogue pain score was 0.9 out of 10 (range: 0-6) and a single complication was observed. Conclusions: The use of IMS in metacarpal fracture fixation is a practicable surgical option. IMS fixations yields a satisfactory duration for return to function, good postoperative range of movement, modest pain scores and low rates of complications. Level of Evidence: Level IV (Therapeutic).

Outcomes Following Fully Threaded Intramedullary Nailing of Metacarpal Fractures

Purpose

Intramedullary screw fixation has emerged as a popular approach for the treatment of displaced metacarpal fractures. The purpose of this study was to investigate the functional and radiographic outcomes of a newly designed, headless noncompressive fully threaded intramedullary nail (TIMN) for the treatment of metacarpal fractures.

Methods

A retrospective chart review was performed on patients who were treated with the INnate TIMN (ExsoMed) at a single academic institution with a minimum of 1-year follow-up. Patient-reported functional outcomes included Quick Disabilities for the Arm, Shoulder, and Hand (QuickDASH) questionnaires, return to work and physical activity time, and overall satisfaction. Radiographs were retrospectively reviewed to determine radiographic union, change in angulation, and metacarpal shortening.

Results

A total of 49 patients (58 fractures) with a mean age of 36 years (range: 17-75 years) were included. The mean follow-up time was 2.7 years (range: 1.4-4.3 years). Overall, the mean patient satisfaction rating was 4.9 of 5 (range: 3-5). The mean return to work time was 7.2 weeks (range: 0.14-28 weeks), and the mean return to sport or activity was 8.3 weeks (range: 1-28 weeks). Average QuickDASH scores across all patients were 4 (range: 0-56.9). The median radiographic healing time was 6.1 weeks (range: 4.7-15.4 weeks). Mean postoperative shortening in the fifth metacarpal fracture was 3 mm (range: -4.2 to 8 mm) at the initial postoperative visit and 3.6 mm (range: -3.3 to 7.9 mm) at the final radiographic follow-up. Subgroup analysis showed that postoperative shortening was similar, regardless of the fracture pattern. The following four complications were reported: one case of persistent pain and stiffness, one case of carpal tunnel syndrome, one nonunion, and one fractured intramedullary nail.

Conclusions

Our findings suggest that the TIMN allows for a reliable return to work and physical activity, high patient satisfaction, low complication rate, and minimal shortening at the final radiographic follow-up.

Type of study/level of evidence

Therapeutic IV.