Post-Operative Outcomes of Metacarpal Neck Fractures Treated with Intramedullary Screw Fixation or Percutaneous Pinning
Tiffany N Bridges, DO1, Stephanie A. Kwan, DO1, Johnlevi Lazaro, DO1, Christopher Jones, MD2, Jonas Matzon, MD3 and Michael Rivlin, MD4, (1)Jefferson Health - New Jersey, Stratford, NJ, (2)Orthopaedics, Rothman Orthopaedic Institute, Philadelphia, PA, (3)Rothman Orthopaedics, Sewell, NJ, (4)Rothman Orthopaedic Institute, Philadelphia, PA
Metacarpal fractures are one of the most frequently encountered orthopaedic injuries. Metacarpal neck fractures can be treated surgically with either intramedullary screw fixation (IMS) or closed reduction percutaneous pinning (CRPP). Certain metacarpal fractures are amenable to both modalities. The purpose of this study is to compare the functional outcomes and complication rates between these two techniques.
All patients with metacarpal neck fractures treated with either IMS or CRPP between 2015 to 2021 at a single, large private-academic institution were retrospectively identified. Metacarpal neck fractures amendable to both modalities that had at least one postoperative follow-up visit were included in the study. All electronic medical records were reviewed for patient-reported outcome measures such as QuickDASH as well as complications and active range of motion (ROM) of the metacarpophalangeal (MCP) joint until final postoperative visit. Complications were subdivided into major and minor complications.
A total of 83 patients (62 IMS, 21 CRPP) met inclusion criteria. Age at the time of procedure, sex, hand dominance, and laterality were similar amongst both groups. Postoperative functional scores were similar among both groups with an average of 20.4 for IMS and 33.9 for CRPP. Active MCP joint range of motion at final postoperative visit was significantly greater in flexion in the IMS group compared to CRPP group (88° vs 85). However, there was no significant difference in active extension (1° vs 1°). Overall complication rate was not significantly different between the 2 groups (25% vs 24%), which again held true when subdivided into major complications (13% vs 5%) and minor complications (12% vs 19%).
DISCUSSION and CONCLUSION
Acceptable outcomes can be achieved with both IMS and CRPP when treating metacarpal fractures, as is evident by their similar QuickDASH scores and complication rates. However, patients treated with IMS may have improved postoperative flexion compared to CRPP. Therefore, patients should be counseled on such limitations when preoperatively discussing surgical options for these injuries.
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