Assessing the Return of Function After Various Approaches to Stable Fixation of Metacarpal Fractures

Multiple approaches exist for operative fixation of metacarpal fractures; with common treatments including lag screw fixation or open-reduction internal fixation (ORIF) with plates and screws. Recently, the adaptation of intramedullary screw (IMS) placement has allowed for an essentially closed approach with stable fixation and theoretically improved outcomes. Thus, we sought to compare such approaches to ultimately determine the superior method for achieving the goal of return to normal function.

We performed a retrospective study of all patients in our institution with metacarpal fractures requiring operative fixation over a 10-year period, with at least 6 months follow-up. Preoperative demographics, fracture characteristics, and operative data were collected. First digit metacarpal fractures along with any occurring at the base of the bone were excluded, as IMS fixation is not typically performed in such cases. Postoperative outcomes, including range of motion, hand therapy requirements, and time to subjective recovery were also compared.

A total of 154 metacarpals were included in this study. Patients treated via IMS experienced shorter operative and tourniquet times compared to ORIF, with a faster return to subjective normal function, a greater range of motion, and reduced need for hand therapy. Complication rates were similar. This held true in isolated metacarpal fractures as well.

Intramedullary screw exhibited improved functional outcomes when compared against ORIF, exhibiting improved patient outcomes with comparable complication rates and should be considered as a method for fixation of metacarpal fractures within appropriate settings.