AAHS Home  |  2021 Virtual Portal  |  Past & Future Meetings
American Association for Hand Surgery

Back to 2022 ePosters


Antegrade Approach to Intramedullary Headless Compression Screw Placement for Metacarpal Fractures: A Case Series
Lawrence Z Cai, MD, Stanford Plastic and Reconstructive Surgery, Palo Alto, CA and Don Hoang, MD, MHS, Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, NORTHRIDGE, WA

Introduction: Metacarpal fractures are common in the upper extremity, and for transverse and short oblique fracture patterns, intramedullary headless compression screws (IMHCSs) can be an appropriate fixation technique. Recently, an antegrade approach to IMHCS placement has been described, which circumvents the concerns around the traditional retrograde approach - such as creating defects in the extensor tendon, the sagittal hood, and the articular surface of the MCPJ. Here, we describe our experience with the antegrade approach to IMHCS placement.
Materials and methods: A retrospective chart review was performed for all patients who had undergone fixation of metacarpal fractures via an antegrade approach to IMHCS. Charts were reviewed for patient factors (age, gender, handedness, occupation), injury characteristics (date of injury, mechanism of injury, digits involved), operative details (date of surgery, type and size of screw), and long-term outcomes (range of motion, complications). QuickDASH scores were also obtained from patients that could be contacted at 6 month follow-up.
Results: A total of 22 metacarpal fractures (20 patients) were treated with antegrade IMHCS fixation during the study period. Patient comorbidities include tobacco use (n=6), diabetes (2), and active methamphetamine use (2). Common mechanism of injuries include punching an object (11), motorcycle accident (3), and ground level falls (3). A majority of patients had fixation performed within two weeks of injury, and patients were followed for an average of 11.5 weeks. At final follow-up, 14 patients have full range of motion of the injured digit, and five patients are able to form a composite fist with 1cm or less of gapping at the injured digit. The median QuickDASH Disability Score was 8.0 (IQR 6.8 - 9.1).
Conclusions: Antegrade approach to IMHCS placement is a safe and effective approach for fixation of transverse and short oblique metacarpal fractures. Patients have full or nearly-full recovery of range of motion and very minimal disability following fixation.


Back to 2022 ePosters