Surgical outcomes of intramedullary screw fixation for metacarpal fractures: a systematic review

Background: Metacarpal fractures account for 33.3% of hand fractures. New surgical techniques have been developed to address this common injury, including retrograde intramedullary (IM) screw fixation. This technique has grown in popularity in recent years and has shown promising results but has been met with skepticism by some surgeons because of the lack of adequate large-scale outcome studies. The purpose of this study was to review all existing literature on clinical and functional outcomes for metacarpal fractures managed operatively with IM screw fixation. Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical and functional outcomes as well as complications were analyzed. Results: The database search yielded 12 studies, including a total of 554 metacarpal fractures that were surgically managed with IM screw fixation. Average follow-up after surgery was 23.1 wk. Fracture union rate was 100%. Postoperative grip strength was shown to average 99.3% that of the contralateral uninjured hand. Total active range of motion averaged 249.8 degrees. The overall complication rate was 5.6%, and 3.1% required a second surgery. Conclusions: This systematic review demonstrated that intramedullary screw fixation for metacarpal fractures yields excellent clinical and functional outcomes with low complication rates. IM screw fixation provides rigid internal fixation with minimal soft-tissue dissection without extramedullary hardware, thus precluding the need for prolonged postoperative immobilization and limiting the potential for extensor tendon adhesions and digital stiffness. IM screw fixation is a viable and safe option for surgical management of metacarpal fractures. Level of Evidence: Level III.