Clinical outcome of Intramedullary Screw Fixation in Metacarpal and Phalangeal Fractures

Hand fractures of the metacarpals and phalanges account for up to 10% of all skeletal injuries and can lead to significant functional impairment if not managed appropriately. Retrograde intramedullary headless screw (IMHS) fixation is a minimally invasive technique that promises stable fixation and early mobilization, but its clinical efficacy in a prospective setting warrants evaluation.

A prospective interventional study was conducted at tertiary care center from May 2023 to October 2024. Forty adult patients with simple, extra-articular metacarpal or phalanx fractures were enrolled; six were lost to follow-up, leaving 34 for analysis. Fractures were stabilized using retrograde IMHS fixation. Functional recovery was assessed at 3 weeks, 3 months, and 6 months postoperatively using the disabilities of the arm, shoulder and hand (DASH) score, hand grip strength, and total active motion (TAM) per American Society for Surgery of the Hand criteria.

The mean patient age was 29.29 ± 8.52 years; 82.4% were male, and 52.9% had injuries in the dominant hand. Shaft fractures predominated (83.8%). (1) DASH score improved from 47.07 ± 7.29 at 3 weeks to 27.30 ± 2.59 at 3 months and 1.32 ± 1.51 at 6 months (all P < 0.001). (2) Grip strength increased from 11.09 ± 1.75 kg at 3 weeks to 24.38 ± 3.46 kg at 3 months and 39.74 ± 4.69 kg at 6 months (all P < 0.001). (3) TAM rose from 116.18 ± 11.81° at 3 weeks to 154.71 ± 14.61° at 3 months and 268.53 ± 17.78° at 6 months (all P < 0.001).

Retrograde IMHS fixation offers stable fracture stabilization with minimal soft-tissue disruption, enabling early mobilization and resulting in excellent functional recovery for metacarpal and phalangeal fractures.