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Intramedullary Screw Subsidence Following Metacarpal Fixation
Jasmine Lee, MD, MS
1, Eren Ucar, BA
2, Vipul Patel, MD
2, Jonathan L Bass, MD
1; Nikhil A Agrawal, MD
1(1)NYU Langone Health, New York, NY, (2)New York Hand Surgery, Brooklyn, NY
IntroductionIntramedullary screw fixation is an emerging technique for metacarpal fracture management that has demonstrated promising functional outcomes. In this study, we present our clinical experience with this method and hypothesize that significant subsidence may occur during the acute postoperative period.
MethodsA retrospective chart review and radiological analysis was performed for patients who have undergone intramedullary screw fixation of metacarpal fractures through a percutaneous retrograde approach, with a minimum follow up of 6 weeks across three institutions with four different surgeons. Patients charts were reviewed and demographic parameters, implant characteristics, indications, and complications were documented. The baseline position of the screw head relative to the distal cortex was measured from the first post operative x-ray, taken within 2 weeks after surgery. The intramedullary nail was used as a known reference object for calibration to avoid potential errors caused by magnification or angulation error. Distance from the distal tip of the screw head to the distal cortex was measured over time at subsequent post operative x-rays.
A paired t-test was conducted to compare baseline screw position relative to the distal cortex to screw position at follow up between 4-6 weeks postoperatively.
ResultsTwenty-one metacarpal fractures amongst 19 patients were analyzed. Mean age was 33.7±11.1 years, 81% of patients were male. The majority of fractures were of the small finger (n=12,57.1%), then ring (3,14.3%), index (3,14.3%), middle (2,9.5%), and thumb (1,4.8%). 52.6% were non smokers, 21.1% were former smokers, and 26.3% were active smokers. There was one case of screw subsidence with distal intra-articular penetration requiring screw removal, and another case of screw removal per patient request.
There was a significant decrease in distance from distal cortex to screw head of 0.78 mm±0.98 (CI 0.32,1.19; p=0.002) from baseline post operative x-ray to second postoperative follow up at 4-6 weeks.
ConclusionAfter retrograde intramedullary screw fixation of metacarpal fractures, distance from the screw head to the distal cortex decreases significantly over time within 6 weeks postoperatively, suggesting acute subsidence of the metacarpal nail. The large standard deviation in the average change in distal screw position may reflect different clinical trajectories of subsidence. Further studies with larger patient samples are necessary to characterize the different rates of subsidence
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