Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls

Abstract

Background: Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures after distal radius fractures with varying methods of fixation techniques. Intramedullary screw fixation is an increasingly preferred method of fixation. Benefits include early range of motion, faster recovery, limited dissection, and reduced complications. Improper technique, which is readily avoidable, can lead to suboptimal results. Methods: A review of recent literature on current techniques aims to summarize the biomechanics of intramedullary screw fixation and outline appropriate technique of placing headless compression screws for metacarpal and phalangeal fractures. Results: We discuss through images and videos the indications, preoperative workup, and technical pearls and pitfalls to encourage surgeons to add this technique to their armamentarium and improve outcomes. Conclusions: intrameduallry screw fixation is a powerful option for metacarpal and phalanx fixation that allows rigid stability, enabling early return of function with excellent rates of union and total active motion. With knowledge of technical pearls presented in this article, common mistakes can be avoided to improve efficiency of screw placement and optimize patient outcomes.

Percutaneous Retrograde Technique Using Intramedullary Headless Compression Screws for Metacarpal Fractures Under Wide-Awake Local Anaesthesia No Tourniquet

“…This shows that it is safe to mobilize these patients immediately without splints/plasters. The other advantage of this fixation is its usefulness in multiple metacarpal and phalangeal fractures in early mobilisation and rehabilitation [ 8 ].…”

“…The surgeons measured the metacarpal bone preoperatively to ensure the selection of the proper screw size by measuring the entire width of the bone and the narrowest width of the medullary canal isthmus, which are different for each finger. The surgeons ensured the screw was long enough to sustain the excessive forces and reduce the torsional forces on the fracture site [ 8 ]. They reduced the fracture (checked by mini C-arm) by flexing the metacarpophalangeal (MCP) and proximal joint to 90° and pushing the proximal phalanx towards the metacarpal head using the Jahss manoeuvre [ 11 ].…”

“…These include the chance of infection (7%), loosening/migration of the pin tract (5%), nonunion (4%), and immobilization of the patient with splints or plasters for several weeks [ 6 , 7 ]. However, the retrograde intramedullary screw fixation technique has gained popularity in recent years as it avoids the need for immobilization and prevents scarring and stiffness because it does not involve opening the fracture site [ 8 , 9 ].…”

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

“…6). [9][10][11] The disadvantage is the potential risk of rotational deviation by the screw, which is minimized by a cotton soft-spica. There is also the difficulty of screw removal in the event of breakage or bending of the screw due to a secondary injury or bone overgrowth, making screw extraction challenging.…”

Iliac Crest Bone Graft With Intramedullary Headless Implant for Metacarpal Bone Loss

“…Open reduction with plate fixation allows for adequate reduction and enhanced stability, but the disadvantages include a larger incision, increased stiffness, and extensor lag. 7 An alternative for fixation depending on the fracture pattern is the intramedullary screw, a less invasive technique that allows for an earlier range of motion. An intramedullary screw was utilized in both of our patients after graft placement to restore bony continuity and allow for resistance to bending and torsional forces.…”