Expedited return to play following intramedullary headless screw fixation of metacarpal fractures in elite athletes
Gilad Pinchas Eisenberg, MD; Tel Aviv Medical Center, Tel Aviv, Israel
Elite athletes hand injuries are of great concern for future career and expedited return to play is essential. IMHS fixation had shown promising results in previous publications. Hence, we have evaluated clinical, functional, and radiographic outcomes and time to return to play following limited open intramedullary headless screw (IMHS) fixation of metacarpal neck and shaft fractures in elite athletes.
Retrospective review of prospectively collected data on a consecutive series of 16 elite/professional athletes (14 men; 2 women), mean age 21 years (range, 19-28 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N=12) and shaft (N=4) fractures at a single academic practice between 2010 and 2017. Four were professional athletes (two Major League Baseball and two National Hockey League players) and two division 1 collegiate hockey athletes were NHL draft picks. Preoperative magnitude of metacarpal neck angulation averaged 52° (range, 45° to 65°), and shaft angulation averaged 35° (range, 25° to 50°). Patients used a hand-based orthosis until suture removal and initiated early protected range of motion within 5 days. Strengthening was initiated when clinical union was demonstrated (no tenderness at fracture site). Clinical outcomes were assessed with goniometer, grip strength and time to return to full play. Time to union and radiographic arthrosis was assessed. Mean follow up was 10 months (range, 1- 43 months).
All 16 patients achieved full composite flexion. All patients demonstrated full active metacarpophalangeal joint extension/hyperextension. Grip strength measured 99% (range, 72% to 118%) of the contralateral hand. All patients achieved radiographic union by 7 weeks. There was no radiographic arthrosis at latest follow-up. Mean return to full play was 5 weeks. Eight patients returned to full play within 4 weeks.
Limited open retrograde IMHS fixation is safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allows for early postoperative motion without affecting union rates, and obviates immobilization. This technique is stable enough to allow early rehabilitation and expedited return to play in elite and professional athletes, and obviates the need for K-wire fixation or formal open reduction and internal fixation.
Type of study/level of evidence Therapeutic IV
Key words: Metacarpal fracture, hand trauma, headless screw, intramedullary fixation, minimally invasive surgery, clinical outcomes, athletes.
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