Use of compression screw in a metacarpal head Fracture: The "lollipop" technique

Only 4 % of metacarpal fractures affect the distal articular region. In the literature, some studies have ended up causing confusion by mixing up extraarticular neck fractures with subcapital fractures, a term that should only be used to define transverse articular fractures of the head that are distal to the origin of the collateral ligament. Due to the need for anatomical reduction, displaced metacarpal head fractures must be reduced and fixed, mostly by open surgery. Recently, the use of intramedullary fixation has become the method of choice in the treatment of transverse metacarpal diaphyseal and neck fractures. Having this in mind, we describe the so-called "lollipop" technique for the treatment of subcapital metacarpal fractures, in which a cortical mini-fragment screw is inserted through the head by intramedullary retrograde fixation in the diaphysis, leaving the final assembly in the shape of the candy. By using minimal fixation, the already impaired vascularity of the head articular fragments is protected, providing enough rigid stability for the fracture to heal in an anatomical position and allowing early mobility.