AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Past & Future Meetings


Back to Annual Meeting Posters


Clinical Outcomes of Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures
David Ruchelsman1; Mark Belsky1; Matthew Leibman1; Sameer Puri2; (1)Newton Wellesley Hospital, (2)Tufts University School of Medicine
Division of Hand Surgery, Newton-Wellesley Hospital/Tufts Univ., Newton, MA, USA

Background: Fixation countersunk beneath the articular surface is well-accepted for peri-articular fractures. Quantitative 3D-CT data supports the use of an articular starting point for extra-articular metacarpal fractures. Intramedullary headless compression screw (IMHS) fixation offers clinical advantages over percutaneous Kirschner wire and open techniques.

Purpose: To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde IMHS fixation for metacarpal neck and shaft fractures.

Methods: Design: Retrospective review of prospectively collected data on a consecutive series of 20(18M; 2F) patients, mean age 32(range, 16-66) treated with IMHS fixation for displaced neck/subcapital fractures at a single academic hand surgical practice between 2010-2012. This technique was also used in an acute axially-stable shaft fracture (n=1) and for three nascent malunions (neck, n=2; shaft, n=1).The dominant hand was involved in 17/20 cases (85%). All patients began active motion within the first postoperative week. A hand based splint was utilized until suture removal. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis at latest follow-up was assessed. 16 of 20 patients reached mean follow up of 6.0 months (range, 121.8).

Results: All patients achieved full composite flexion with pad-to-distal palmar crease distance=0 mm. All patients demonstrated full active MP extension or hyperextension at latest follow-up. Grip strength measured 94% (range, 65-116) of the contralateral hand. No secondary surgeries were performed. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported an occasional click with MP motion that did not require further treatment.

Conclusion: Limited open minimally invasive retrograde IMHS fixation is a safe and reliable technique for metacarpal neck/subcapittal and axially-stable shaft fractures; allows for early postoperative active motion without affecting union rates; obviates immobilization; and avoids complications associated with K-wire and plate/screw constructs. This technique offers distinct advantages in select patients (i.e. athletes). Technique, current indications, pearls and pitfalls are reviewed.

Image 1.jpg

Image 2.jpg

Image 3.jpg


Back to Annual Meeting Posters

 

© 2020 American Association for Hand Surgery. Privacy Policy.