Postoperative Outcomes Following Metacarpal Neck Fractures Treated With Intramedullary Screws Versus Closed Reduction...

Metacarpal neck fractures are frequently encountered by hand surgeons. Certain operative metacarpal neck fractures are amenable to both retrograde intramedullary screw (IMS) fixation and closed reduction percutaneous pinning (CRPP). The purpose of this study was to compare functional outcomes and complications following these two techniques.

All patients with metacarpal neck fractures treated with either IMS or CRPP from 2015 to 2021 at a large private academic institution were retrospectively identified. Electronic medical records were reviewed for demographics, Quick Disabilities of Arm, Shoulder, and Hand (qDASH) scores, metacarpophalangeal joint range of motion (ROM), and complications.

A total of 113 patients, consisting of 57 in the IMS cohort and 56 in the CRPP cohort, were included. The CRPP cohort was significantly younger, otherwise demographics were similar between both groups. Both cohorts had similar preoperative (47.5 IMS vs 43.9 CRPP), postoperative (17.6 IMS vs 9.9 CRPP), and delta (35.5 IMS vs 34.0 CRPP) qDASH scores. Retrograde IMS allowed for greater flexion at 4 to 6 weeks (81° vs 65°) postoperatively. The overall incidence of complications was similar among IMS and CRPP (21.1% vs 17.9%), although IMS had significantly more major complications (8.8% vs 0%).

Despite earlier return to ROM, operative fixation of unstable metacarpal neck fractures with retrograde IMS may be at higher risk of major hardware complications and extensor lag.