Bent Intramedullary Metacarpal Implants

Metacarpal fractures are common injuries that can lead to debilitating outcomes if not treated appropriately. Intramedullary fixation has gained popularity as a treatment option, allowing for earlier mobilization with few reported complications.

A retrospective chart review of all patients treated with intramedullary implants for a metacarpal fracture between August 2018 and February 2024 at a single center was performed. Medical records and radiographs were reviewed to identify instances of hardware failure/bent implant. In patients with bent implants, the mechanism of re-injury was recorded.

648 total metacarpal fractures were surgically treated during the study period, with 90 patients receiving intramedullary fixation (56 ExsoMed INnate, 31 Acumed acutrak, 3 Arthrex headless compression screw). Five patients (7 screws) experienced postoperative hardware failure/bending of the implant, all resulting from a punching mechanism. Furthermore, all patients with postoperative hardware failure sustained their initial metacarpal fracture as a result of a punching mechanism. Additionally, 1 patient initially treated at an outside hospital presented with a bent implant following a punching-related reinjury. All affected patients were male, and the time from initial surgery to implant failure ranged from 4 weeks to 7 months.

This series highlights a notable complication (bent implant) associated with intramedullary fixation of metacarpal fractures and includes our strategy for implant removal. Furthermore, we now consider patients with a history of closed-fist striking as a mechanism of injury as a contraindication to intramedullary metacarpal fixation due to this complication.