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Unstable Metacarpal Fractures Treated with Intramedullary Nail Fixation
Ather Mirza, MD; Justin B. Mirza, DO
Ather Mirza, Smithtown, NY

Introduction: Fractures of the metacarpals account for nearly 36% of all hand fractures. While many metacarpal fractures can be treated through nonsurgical means, unstable metacarpal fractures which are subject to malrotation, displacement, foreshortening and angulation require reduction and stable fixation. Flexible intramedullary nail (IMN) fixation of fractures has become the cornerstone of treatment of long bone fractures with the medullary cavity. It provides distinct advantages over other methods because it is minimally invasive with minimal soft tissue dissection, stability of fixation, and enhancing bone healing by preventing distraction of the fracture site. This is a particularly great option for patients presenting multiple metacarpal fractures. Our study evaluates outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation.

Materials & Methods: This study includes 55 cases of fractures healed by clinical and radiographic assessment at an average of 12.7 weeks. There were 39 males and 16 females, with an average age of 33.9 years (range, 15 to 78 years). An internal fixation device (straight, flexible stainless steel nail with a blunt, bent tip; 1.2/1.6 mm) was introduced through the fenestration and threaded through the medullary cavity under fluoroscopic guidance. A removable orthosis, instead of a cast, allowed for mobilization of the PIP joint. The outcomes were assessed via a radiological study of longitudinal and angular collapse, and final functional outcome as measured by DASH, AROM and Grip and Pinch Strength tests.

Results: Pins were removed in all cases at an average of 13.9 weeks. Patients regained full finger range of motion at final follow-up and were capable of 72.4% of motion at two weeks post operatively. Mean DASH score at final follow-up was 6.5. Complications included three cases of extensor tendon irritation that resolved without functional impairment and two cases of “backing out” that required reoperation to replace the pin. In one case, a bony extosis formed on the affected metacarpal that led to tendon irritation and required operative excision.

Conclusions: We found that this technique allowed for stabilization of fractures, early range of motion with early resumption of usual activities, reduced immobilization, and minimal complications. This is confirmed by the results, as the study’s patients regained 72.4% finger ROM two weeks postoperatively and full ROM at final follow-up. Intramedullary nails also allowed patients presenting foreshortened character to regain metacarpal length. Furthermore, this procedure facilitated rehab and enhanced patients’ daily functional routines.


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