Anterograde Intramedullary Headless Compression Screw for Managing Extra-articular Thumb Metacarpal Base Fracture: Technique and Report

Abstract

Extra-articular base fractures of the thumb are typical in hand surgeon practice. Nonoperative methods (spica) and operative methods are available for its management. There are operative methods described, such as plate and screws, Kirschner wires, and intramedullary screws. However, there is only a retrograde technique described. This study aims to present a new technique of an anterograde intramedullary headless compression screw to manage the extra-articular thumb metacarpal base fracture. This minimally invasive method allows an early range of motion and does not cross the articular surface of the thumb. This alternative fixation method has the advantage of low damage to soft tissues and good functional outcomes.

Curative effect of external fixation combined with kirschner wire versus hollow screw in the treatment of first metacarpal bone base fracture

“…However, it is essential to note that the strength of external fixation combined with Kirschner wire fixation is inferior to that of the hollow screw fixation. [ 25 ] The main advantages of using hollow screw fixation are as follows [ 26 , 27 ]: (1) hollow screw is drilled through Kirschner wire guide, which causes less damage to the peripheral blood supply and the soft tissue surrounding the fracture. Also, this method reduces the likelihood of causing trochlear necrosis during the surgery, which is beneficial for postoperative fracture healing; (2) due to the threaded structure at the top of the cannulated screw, the broken ends can be brought into close contact by compression, leading to better anatomical reduction of the articular surface, firm fixation, and earlier fracture healing than Kirschner wire fixation; (3) the internal fixation has little effect on the joint, enabling postoperative joint movement, and relatively reliable fixation, which is conducive to early postoperative rehabilitation; (4) there is minimal impact of the hollow screw on the tendon, which helps to avoid tendon wear and rupture.…”