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Systematic Review of Intramedullary Fixation for Metacarpal Fractures
Joseph P. Corkum, BEng; Peter G. Davison, BSc, MD; Donald H. Lalonde, BSc, MSc, MD; Dalhousie University
Dalhousie University, Halifax, NS, Canada


Intramedullary (IM) fixation has been described as a reliable method of treatment for certain metacarpal fracture patterns but has not been widely adopted into practice. The purpose of this study was to evaluate the literature that compares IM fixation to other forms of treatment and to determine which fracture patterns are most appropriate for IM fixation.


A systematic review was performed using Cochrane Library, MEDLINE, and EMBASE databases to identify studies investigating the treatment of metacarpal fractures using IM fixation. Inclusion criteria were of comparative studies of IM fixation with any other form of treatment, surgical or non-surgical. Studies were excluded if they involved intra-articular fractures, pediatric patients, or were non-clinical. Two reviewers independently identified appropriate articles for review based on eligibility criteria. Outcome measures were: validated outcome questionnaires, range of motion (ROM), grip strength, complication rates, patient satisfaction, and pain measured on a visual analog scale (VAS).


Eight studies were eligible for review. Studies were of level II – III evidence and captured a total of 435 patients (211 treated with IM fixation and 224 treated conservatively or with other surgical techniques). IM fixation had shorter operative times compared with plate and screw fixation and locking IM fixation. In all studies it was deemed to be equal or superior to its counterpart. Patient satisfaction was similar when measured. Postoperative ROM was greater for IM fixation patients in half of the studies, whereas it was similar in the other half. VAS pain scores were either lower with IM or not statistically different. Grip strength was ultimately similar between groups, but IM fixation took longer to reach par in one level II evidence article.

A formal meta-regression analysis was not possible given the heterogeneity of studies. However, a qualitative summary of the authors’ conclusions from the studies favors displaced, unstable shaft and neck fractures as the most suitable patterns for treatment with IM fixation.


No conclusive recommendations can be made based on the available studies included in this exhaustive literature search. However, IM fixation may have a role in the treatment of displaced, unstable shaft and neck fractures, as the surgery is less invasive and the outcomes seem to be similar or better. High level evidence comparing IM fixation with other treatment methods is lacking and warranted.

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