Outcomes of Metacarpal Shaft Fractures Treated by Open Reduction Internal Fixation With Plates and Screws Versus...

Metacarpal fractures are among the most common orthopedic injuries. When metacarpal shaft fractures require surgical fixation, common options include closed reduction percutaneous pinning, open reduction internal fixation (ORIF) using plates and screws (PS), and intramedullary screw fixation (IMS). Certain metacarpal shaft fractures are amenable to ORIF with either PS or IMS. The purpose of this study is to compare the functional outcomes and complication rates between these techniques.

A retrospective review was performed of all patients that underwent ORIF with PS or IMS of metacarpal shaft fractures between the years 2015-2021 at a single, large private-academic institution. Postoperative patient-reported outcome measures were collected and medical records were reviewed for complications and range of motion (ROM). In addition, complications were subdivided into major and minor complications in accordance with previously published data on the subject.

A total of 120 patients (60 PS, 60 IMS) were included in this study, and each of the groups were similar in age at the time of procedure, sex, hand dominance, laterality, and mechanism of injury. Postoperative functional scores were similar among both groups. Metacarpophalangeal joint ROM in the acute postoperative period was significantly greater in the IMS group when compared with PS. The overall complication rate was not significantly different between the 2 groups.

When treating metacarpal shaft fractures, both ORIF with PS and IMS can achieve acceptable outcomes. Patients treated with either fixation method should be counseled on the risk of developing symptomatic hardware that may require removal.