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Intramedullary Headless Cannulated Screw Fixation of Subcapital Metacarpal Fractures: an Alternative Technique
Melissa A. Klausmeyer, MD; Chaitanya S. Mudgal, MD
Massachusetts General Hospital, Boston, MA

Hypothesis: Multiple methods of fixation have been described for metacarpal fractures. However, stable fixation of subcapital metacarpal fractures is difficult using traditional techniques secondary to suboptimal purchase of periarticular bone and in comminuted fractures. Intramedullary screw fixation may be useful for stable fixation of metacarpal fractures, particularly subcapital fractures.
Methods: Ten fractures in 9 patients (age 21-74, average 43 years old) underwent open reduction and internal fixation of subcapital metacarpal fractures with a cannulated headless 3.0 mm intramedullary screw. Three patients also had plate and screw fixation of an associated metacarpal shaft or base fracture.
Results: Follow up averaged 2 months (Range 0.5-7). All patients began an early active range of motion protocol. The six patients with longest follow up had full range of motion. Three patients who were lost to follow up within one month or less had some limitation in range of motion noted (0-85° average) on last visit. The post-operative course was uneventful. Post-operative radiographs revealed well-maintained height and alignment of the fractures.
Summary Points: Intramedullary screw fixation provides stable internal fixation for subcapital metacarpal fractures. With this alternative technique, there is minimal disruption of the soft tissues or fracture hematoma. It allows for early rehabilitation and good clinical results.


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