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Outcomes of Metacarpal Fracture Fixation Using the ExsoMed INnate Threaded Intramedullary Nail
Cameron Cox, BBA, Alec Giron, BS, Desirae McKee, MD and Brendan J MacKay, MD, Texas Tech University Health Sciences Center, Lubbock, TX

Introduction
Metacarpal fractures are frequently treated by hand surgeons; however, no single fixation technique has emerged as a gold standard. K-wire fixation is used for its simplicity and flexibility, but requires extended immobilization and carries a high rate of complications. Dorsal metacarpal plating provides greater stability, but complication rates remain high. Intramedullary threadless nails are associated with reduced time to union and improved ROM, but may not provide equivalent stability.
Headless intramedullary screws allow for rapid return to activity and increased stability. However, compression forces may shorten the metacarpals and produce non-anatomic final structures. The ExsoMed INnateTM threaded intramedullary nail was developed with threads spaced further apart to reduce compressive forces while maintaining stability.
We hypothesized that time to radiographic union and postoperative pain would be reduced, and that early ROM would be improved when using headless threaded intramedullary nails were used for fixation.

Materials & Methods
VAS pain scores, current pain medications, percent return to normal activity, range of motion (ROM), and presence/absence of radiographic union were recorded at each postoperative follow up visit. Descriptive statistics were performed to evaluate endpoints.

Results
71 fractured metacarpals were included in our study. The 4th and 5th metacarpals were the most common site of injury. The most common mechanisms of injury were blunt object and MVC.
Average time to radiographic union was 8.8 weeks (n = 28, range: 4.1-17.7 weeks). Average VAS pain score was 0.5 (n = 33, range: 0-7) at most recent follow up (mean: 10.2 weeks, range: 0.9-68.7 weeks). Average percentage of normal activity resumed was 87.4% (n = 38, range: 50-100%) at most recent follow up (mean: 10.2 weeks, range: 0.9-68.7 weeks).
At most recent follow up (mean: 10.2 weeks, range: 0.9-68.7 weeks), 52% of patients (13/25) had 100% total active motion (TAM), 32% (8/25) had 75-99% TAM, 8.0% (2/25) had 50-75% TAM, and 8.0% (2/25) had 25-50% TAM. 78.1% of patients (25/32) were able to make a composite fist at most recent follow up (mean: 11.3 weeks, range: 0.9-68.7 weeks).

Conclusions

  • Threaded intramedullary nails provide benefits of headless intramedullary screws, without the concern for compression and metacarpal shortening.
  • Our cohort includes more severe and/or complex injuries than those included in similar published studies.

Preliminary results suggest that threaded, intramedullary nails may provide equivalent outcomes across a broader spectrum of fracture and/or concomitant injury patterns.
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