Functional assessment in patients with metacarpal fractures treated with plates vs intramedullary screws: a scoping...

Metacarpal fractures have an incidence of 8.4 per 10,000 people/year, representing 18-44% of hand fractures, and are more common in men. Various techniques have been described, such as fixation with Kirschner wires, locking plates, and intramedullary screws. The purpose of this review is to compare the functional outcomes reported in the literature.

A scoping review (PRISMA) was conducted, based on the PICO question: «What are the functional outcomes in patients with metacarpal fractures fixed with plates versus intramedullary screws?».

Five retrospective studies, one prospective study, two systematic literature reviews, and one meta-analysis were analyzed.

Kirschner wire fixation is inexpensive and readily available, requires prolonged postoperative immobilization, and is associated with a high rate of infection. The plate and screws provide the most stable fixation, require extensive soft tissue dissection, and are associated with stiffness, extensor adhesions, and infection. Screw fixation maintains reduction and prevents rotational instability, allowing for early mobilization. Joint damage does not exceed 8% of the articular surface. A total of 1,873 patients were included (295 women and 1,578 men), with a mean age of 32years. The fifth metacarpal was the most frequently fractured, and the most common fracture locations were the neck (44.66%), the shaft (38.55%), and the head (10.68%). Regarding functionality, Barrera-Ochoa, DelPrete, and Fatima reported lower QuickDASH scores for intramedullary screw fixation compared to plate fixation (8.62 vs. 4.55). Grip strength was also superior with screws (90.3% for plates, 104.4% for screws). Esteban-Feliu and Barrera report an earlier return to activity, shorter surgical time, less pain, and a lower rate of implant removal procedures in the intramedullary screw group.

The authors conclude that intramedullary screw fixation is a safe, effective, and minimally invasive technique with satisfactory clinical results and minimal complications, offering significant functional advantages over plate fixation.