Volume: 1
Year: 2024, Page: 1-12,
Received: May 2, 2024 Accepted: Sept. 26, 2024 Published: Oct. 10, 2024
Metacarpal fractures are the second and third most common upper extremity fractures after distal radius fractures, with varying fixation techniques. Intramedullary screw fixation is an increasingly preferred method. Intramedullary fixation of a comminuted sub capital metacarpal fracture using a headless compression screw was first described in 2010. The benefits include early range of motion, faster recovery, limited dissection, and reduced complications. Improper techniques that are readily avoidable can lead to suboptimal results. This study aimed to conduct a case-based review of outcomes following surgical treatment of metacarpal fractures. A comprehensive literature search was performed to identify relevant studies. Outcome measures included the mean follow-up, radiographic union, and functional outcomes. The treatment of the metacarpal fractures was good. Non-union is very rare, but malunion is common. Most metacarpal fractures are managed by closed reduction and immobilization and should be considered the primary approach, while open reduction should be reserved for cases where closed reduction is not feasible. This case-based review suggests that intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option, resulting in excellent clinical outcomes.
Keywords: First Metacarpal Screw Fixation Technique – Abductor pollicis longus Approach: Case-Based Review
1. Geissler WB. Operative fixation of metacarpal and phalangeal fractures in athletes. Hand clinics. 2009; 25(3):409-21.
2. Fufa DT, Goldfarb CA. Fractures of the thumb and finger metacarpals in athletes. Hand clinics. 2012; 28(3):379-88.
3. Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clinics in sports medicine. 2015;34(1):69-98.
4. Popova D, Welman T, Vamadeva SV, Pahal GS. Management of hand fractures. British Journal of Hospital Medicine. 2020; 81(11):1-1.
5. Cohen H, Kugel C, May H, Medlej B, Stein D, Slon V, Hershkovitz I, Brosh T. The impact velocity and bone fracture pattern: Forensic perspective. Forensic science international. 2016; 266:54-62.
6. Metacarpal Fracture. Werntz RL, Varacallo M. Metacarpal Fracture. InStatPearls [Internet] 2023. StatPearls Publishing.
7. Carreño A, Ansari MT, Malhotra R. Management of metacarpal fractures. Journal of clinical orthopaedics and trauma. 2020; 11(4):554-61.
8. Wong VW, Higgins JP. Evidence-based medicine: management of metacarpal fractures. Plastic and reconstructive surgery. 2017; 140:140e-51e.
9. Baldwin PC, Wolf JM: Outcomes of hand fracture treatments. Hand Clinics. 2013; 29:621-30.
10. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand. 2014; 9:16-23.
11. Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. Journal of Hand Surgery (American Volume). 2009; 34(5):945-52.
12. Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clinics. 2013; 29:507-18.
13. Foster RJ, Hill Hastings II. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clinical Orthopaedics and Related Research. 1987; 214:121-9.
14. Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. The Orthopedic clinics of North America. 1992; 23(1):19-33.
15. Burkhalter WE. Closed treatment of hand fractures. Journal of Hand Surgery (American Volume). 1989; 14(2):390-3.
16. Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plastic and reconstructive surgery. 2015; 136(3):370e-9e.
17. Shah A, Martin III G, Thomson JG. A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation. Case Reports in Plastic Surgery and Hand Surgery. 2015; 2(1):7-11.
18. Cannon SR, Dowd GS, Williams DH, Scott JM. A long-term study following Bennett's fracture. Journal of Hand Surgery (European Volume). 1986;11(3):426-31.
19. Demir E, Unglaub F, Wittemann M, Germann G, Sauerbier M. Surgically treated intraarticular fractures of the trapeziometacarpal joint—a clinical and radiological outcome study: Klinische und radiologische Ergebnisse. Der Unfallchirurg. 2006; 109:13-21.
20. Jahss SA. Fractures of the metacarpals: a new method of reduction and immobilization. Journal of Bone and Joint Surgery. 1938; 20:178-86.
21. Day CS, Stern PJ. Fractures of the metacarpals and phalanges. Green's Operative Hand Surgery. 2015;231-248.
22. Bhandari M, Swiontkowski M. Introducing the OrthoJOE Podcast: 2 editors, 2 coffees, and 2 times the evidence. Journal of Bone and Joint Surgery. 2021; 103(9):753.
23. Kadow TR, Fowler JR. Thumb Injuries in Athletes. Hand Clinics. 2017; 33(1):161-173.
24. Acosta JR, Graefe SB, Varacallo M. Anatomy, Shoulder and Upper Limb, Hand Adductor Pollicis. StatPearls. 2022.
25. Brown M.T., Rust P.A. Fractures of the thumb metacarpal base. Injury. 2020; 51(11):2421–2428.
26. Cooney 3rd WP, Lucca MJ, Chao EY, Linscheid RL. The kinesiology of the thumb trapeziometacarpal joint. Journal of Bone and Joint Surgery. 1981; 63(9):1371-81.
27. Ridley TJ, Freking W, Erickson LO, Ward CM. Incidence of treatment for infection of buried versus exposed Kirschner wires in phalangeal, metacarpal, and distal radial fractures. Journal of Hand Surgery (American Volume). 2017;42(7):525–531.
28. Shenouda M.E., Mohan A., Sarkhel T. Using a TightRope® to treat a complex fracture of the trapezium. Annals of the Royal College of Surgeons of England. 2014; 96(7): e36–e38.
29. Bruske J, Bednarski M, Niedzwiedz Z, Zyluk A, Grzeszewski S. The results of operative treatment of fractures of the thumb metacarpal base. Acta orthopaedica belgica. 2001; 67:368–373.
30. Griffiths JC. Fractures at the base of the first metacarpal bone. Journal of Bone and Joint Surgery. 1964; 46:712–719.
31. Robinson PJ. Radiology's Achilles' heel: error and variation in the interpretation of the Rontgen image. British journal of radiology. 1997; 70:1085–1098.
32. Avery III DM, Klinge S, Dyrna F, Pauzenberger L, Lam D, Cote M, DiVenere J, Obopilwe E, Mazzocca A, Rodner C. Headless compression screw versus Kirschner wire fixation for metacarpal neck fractures: a biomechanical study. The Journal of hand surgery. 2017; 42(5):392-e1.
33. Melamed E, Hinds RM, Gottschalk MB, Kennedy OD, Capo JT. Comparison of dorsal plate fixation versus intramedullary headless screw fixation of unstable metacarpal shaft fractures: A biomechanical study. Hand. 2016; 11:421–42.
34. Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of metacarpal fractures in the US population. Hand. 2012; 7:426–430.
35. Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiologica. 2009; 50:296–300.
36. Couceiro J, Ayala H, Sanchez M, De la Red MLA, Velez O, Del Canto F. Intramedullary screws versus Kirschner wires for metacarpal fixation, functional, and patient-related outcomes. Journal of surgery. 2018; 4: e29–e33.
37. Ten Berg PW, Mudgal CS, Leibman MI, Belsky MR, Ruchelsman DE. Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. Journal of Hand Surgery (American Volume). 2013; 38:322–330.e2.
38. Giesen T, Gazzola R, Poggetti A, Giovanoli P, Calcagni M. Intramedullary headless screw fixation for fractures of the proximal and middle phalanges in the digits of the hand: A review of 31 consecutive fractures. Journal of Hand Surgery (European Volume). 2016; 41:688–694.
39. del Pinal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. Journal of Hand Surgery (American Volume) 2015; 40:692–70.
40. Jann D, Calcagni M, Giovanoli P, Giesen T. Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws. Hand Surgery and Rehabilitation. 2018; 37:99–103.
41. Pechon PH, Mears SC, Langdale ER, Belkoff SM. Salvaging the pullout strength of stripped screws in osteoporotic bone. Geriatric Orthopaedic Surgery & Rehabilitation. 2013; 4:50–52.
© 2024 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Published by Ascentia Publishers
Saravanamurthy G, Jovanoic N, Alawadi K, Badawi H, Gangadhar C, Saraj B et al. First metacarpal screw fixation technique – Abductor pollicis longus approach: Case-Based Review. Advances in Preclinical and Clinical Research. 2024; 2:202402