Clinical Outcomes of Limited Open Intramedullary Headless Screw Fixation(IMHS) of Metacarpal Fractures - 91 Consecutive Patients
Gilad Pinchas Eisenberg, MD
Tel Aviv Medical Center, Tel Aviv, Israel
IMHS limited open retrograde approach is gaining popularity among surgeons but lack sufficient information. We present a large series, to further evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures.
Retrospective review of prospectively collected data of a consecutive series of 91 patients (79 men; 12 women), mean age 28 years (range, 15y-69y) treated with IMHS fixation for acute displaced metacarpal neck (N = 56) and shaft (N = 35) fractures at a single academic hand practice between 2010 and 2017. 56 patients reached minimum 3-month follow-up. Mean follow-up was10 months (range, 1 to 71 months). Preoperative mean magnitude of metacarpal neck angulation was 470 (range, 00 -900 ), and mean shaft angulation was 420 (range, 00 -700 ). Active motion was initiated within 5 days postoperatively. Clinical outcomes were assessed with digital goniometry and grip strength. Time to radiographic union and radiographic arthrosis was assessed.
All 91 patients achieved full composite flexion (pad-to-distal palmar crease distance = 0mm), and all achieved full active MCP extension or hyperextension. Postoperatvie mean MCP joint flexion-extension arc was 880 (range, 550-1100). Only 3 patients did not obtain great than 650 of isolated MCP flexion. Grip strength measured 103% (range, 58% to 230%) of the contralateral hand. 52 patients achieved radiographic union by 6 weeks (range, 2-12 weeks). At latest follow-up, early arthrosis was noted only in 1 patient (head split component). There were 3 cases of shaft re-fracture after recurrent blunt trauma, following prior evidence of full osseous union with the screw in place, necessitating revision with open reduction and plate-screw fixation.
Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages over formal open reduction and percutaneous K-wire techniques.
Type of study/level of evidence Therapeutic IV
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