Outcomes of Metacarpal Fracture Fixation With Intramedullary Nails: A Systematic Review

Metacarpal fractures are the third most common upper extremity fracture and the second most common hand fracture, resulting in significant disability. This systematic review evaluates the clinical outcomes associated with using intramedullary nails to treat metacarpal fractures.

A qualitative analysis was conducted to analyze summative data and calculate proportions for dichotomous variables and mean and standard deviation for continuous variables.

Seventeen studies involving 761 patients and 815 metacarpal fractures were included. Postoperative recovery of grip strength averaged 89.3% ± 7.7% compared to the unaffected hand. Significant improvement in angulation was noted, decreasing from a preoperative mean of 40.0° ± 9.1° to 11.5° ± 4.3° postoperatively. The mean metacarpal shortening was 2.0 ± 0.8 mm following surgery. The average time to fracture union was 7.3 ± 2.4 weeks, with a mean return-to-work time of 8.1 ± 1.4 weeks. Postoperative functional outcomes were favorable, with mean Disabilities of the Arm, Shoulder and Hand and QuickDASH scores of 4.0 ± 3.6 and 3.9 ± 3.2, respectively. The average postsurgical visual analog scale pain score was 1.1 ± 0.4. The mean postoperative total active arc of motion was 248.6° ± 11.9°.

Intramedullary nailing provides favorable outcomes in the fixation of metacarpal fractures, with significant improvements in grip strength, angulation, and functional recovery.