Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study
Purpose: Intramedullary fixation (IMF) has emerged as an effective treatment for metacarpal fractures. Benefits include stable fixation that allows early postoperative rehabilitation and high fracture union rates, without increased complications. Both headless compression screws and intramedullary t...
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Elsevier
2025-01-01
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| Series: | Journal of Hand Surgery Global Online |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S258951412400197X |
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| author | Michael B. Gehring, MD Brandon Wolfe, BA Riley Kahan, BS Stephanie D. Malliaris, MD Kia M. Washington, MD Matthew D. Folchert, MD Kyros Ipaktchi, MD Mark A. Greyson, MD Alexander Lauder, MD Matthew L. Iorio, MD |
| author_facet | Michael B. Gehring, MD Brandon Wolfe, BA Riley Kahan, BS Stephanie D. Malliaris, MD Kia M. Washington, MD Matthew D. Folchert, MD Kyros Ipaktchi, MD Mark A. Greyson, MD Alexander Lauder, MD Matthew L. Iorio, MD |
| author_sort | Michael B. Gehring, MD |
| collection | DOAJ |
| description | Purpose: Intramedullary fixation (IMF) has emerged as an effective treatment for metacarpal fractures. Benefits include stable fixation that allows early postoperative rehabilitation and high fracture union rates, without increased complications. Both headless compression screws and intramedullary threaded noncompressive nails have been described for this purpose; however, prospective outcomes reporting are lacking. This study assessed the outcomes of metacarpal fractures treated with IMF including patient-reported outcomes, grip strength, total active motion, and complications. Methods: A prospective multicenter trial enrolled consecutive patients with closed, extra-articular metacarpal fractures treated with IMF. Radiographic healing was assessed at each postoperative visit and patient-reported outcomes included pain scores, QuickDASH (Disabilities of the Arm, Shoulder, and Hand), and Short Form Survey scores. Grip strength, goniometric motion measurements, and complications were also obtained. Results: One-hundred-one fractures were treated in 82 patients with an average age of 33 years and mean follow-up of 69 days. Most patients were male (70%), nonlaborers (72%), and nonsmokers (74%). QuickDASH scores improved by 40 points, with a final mean of 17 following metacarpal IMF. Short Form Survey components of physical component score and mental component score at final follow-up were 55.95 and 48.74, respectively. Final average grip strength was 15 kg and total active motion was 228º. The average total active motion of the closed reduction cohort (249°) was significantly higher than the open cohort (210°) at final follow-up (P < 0.05). Four complications (3.9%) occurred, including one hardware failure, two proximal screw migrations, and one metacarpophalangeal joint contracture, with three of these patients requiring revision surgery. Conclusions: Intramedullary fixation is a reliable technique for treatment of extra-articular metacarpal fractures with satisfactory patient-reported outcomes, excellent strength and motion, and a low complication rate. Intramedullary fixation should be considered for closed, extra-articular metacarpal fractures. Type of study/level of evidence: Therapeutic IV. |
| format | Article |
| id | doaj-art-a0ee4c3bbe74461ebc60fb05e68bacee |
| institution | Kabale University |
| issn | 2589-5141 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj-art-a0ee4c3bbe74461ebc60fb05e68bacee2025-01-26T05:04:39ZengElsevierJournal of Hand Surgery Global Online2589-51412025-01-01714855Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes StudyMichael B. Gehring, MD0Brandon Wolfe, BA1Riley Kahan, BS2Stephanie D. Malliaris, MD3Kia M. Washington, MD4Matthew D. Folchert, MD5Kyros Ipaktchi, MD6Mark A. Greyson, MD7Alexander Lauder, MD8Matthew L. Iorio, MD9Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO; Department of Orthopedics, Denver Health Medical Center, Denver, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CODepartment of Orthopedics, Denver Health Medical Center, Denver, CO; Department of Orthopedics, University of Colorado Anschutz Medical Center, Aurora, CODepartment of Orthopedics, Denver Health Medical Center, Denver, CO; Department of Orthopedics, University of Colorado Anschutz Medical Center, Aurora, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CODepartment of Orthopedics, Denver Health Medical Center, Denver, CO; Department of Orthopedics, University of Colorado Anschutz Medical Center, Aurora, CODivision of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO; Department of Orthopedics, University of Colorado Anschutz Medical Center, Aurora, CO; Corresponding author: Matthew L. Iorio, MD, Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center, 12631 East 17th Ave, Aurora, CO 80045.Purpose: Intramedullary fixation (IMF) has emerged as an effective treatment for metacarpal fractures. Benefits include stable fixation that allows early postoperative rehabilitation and high fracture union rates, without increased complications. Both headless compression screws and intramedullary threaded noncompressive nails have been described for this purpose; however, prospective outcomes reporting are lacking. This study assessed the outcomes of metacarpal fractures treated with IMF including patient-reported outcomes, grip strength, total active motion, and complications. Methods: A prospective multicenter trial enrolled consecutive patients with closed, extra-articular metacarpal fractures treated with IMF. Radiographic healing was assessed at each postoperative visit and patient-reported outcomes included pain scores, QuickDASH (Disabilities of the Arm, Shoulder, and Hand), and Short Form Survey scores. Grip strength, goniometric motion measurements, and complications were also obtained. Results: One-hundred-one fractures were treated in 82 patients with an average age of 33 years and mean follow-up of 69 days. Most patients were male (70%), nonlaborers (72%), and nonsmokers (74%). QuickDASH scores improved by 40 points, with a final mean of 17 following metacarpal IMF. Short Form Survey components of physical component score and mental component score at final follow-up were 55.95 and 48.74, respectively. Final average grip strength was 15 kg and total active motion was 228º. The average total active motion of the closed reduction cohort (249°) was significantly higher than the open cohort (210°) at final follow-up (P < 0.05). Four complications (3.9%) occurred, including one hardware failure, two proximal screw migrations, and one metacarpophalangeal joint contracture, with three of these patients requiring revision surgery. Conclusions: Intramedullary fixation is a reliable technique for treatment of extra-articular metacarpal fractures with satisfactory patient-reported outcomes, excellent strength and motion, and a low complication rate. Intramedullary fixation should be considered for closed, extra-articular metacarpal fractures. Type of study/level of evidence: Therapeutic IV.http://www.sciencedirect.com/science/article/pii/S258951412400197XIntramedullary fixationMetacarpal fracturesPatient-reported outcomesThreaded noncompressive nails |
| spellingShingle | Michael B. Gehring, MD Brandon Wolfe, BA Riley Kahan, BS Stephanie D. Malliaris, MD Kia M. Washington, MD Matthew D. Folchert, MD Kyros Ipaktchi, MD Mark A. Greyson, MD Alexander Lauder, MD Matthew L. Iorio, MD Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study Journal of Hand Surgery Global Online Intramedullary fixation Metacarpal fractures Patient-reported outcomes Threaded noncompressive nails |
| title | Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study |
| title_full | Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study |
| title_fullStr | Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study |
| title_full_unstemmed | Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study |
| title_short | Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study |
| title_sort | intramedullary fixation for metacarpal fractures a multi institutional prospective outcomes study |
| topic | Intramedullary fixation Metacarpal fractures Patient-reported outcomes Threaded noncompressive nails |
| url | http://www.sciencedirect.com/science/article/pii/S258951412400197X |
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