Intramedullary Headless Screw Feasibility for Anatomical Reduction in II-V Metacarpal Fractures: A CT-Based...

Background and Objectives: Intramedullary headless screw (IMHS) fixation is a minimally invasive and biomechanically stable option for metacarpal fractures. However, the suitability of commonly used screw diameters may be limited by the morphometric features of the intramedullary canal. This study evaluated the isthmus morphology of the second to fifth metacarpals using computed tomography (CT)-based morphometric analysis and virtual screw simulation. Materials and Methods: A retrospective morphometric study was conducted using 75 hand CT scans, representing 300 metacarpals (second to fifth). Three-dimensional reconstructions were created with Mimics software (Materialise, Leuven, Belgium), and the isthmus level was identified by serial axial CT analysis. Canal diameters were measured at this level, and bone-specific virtual screw models were generated in Rhinoceros 3D and imported into Mimics for virtual implantation and canal conformity assessment. Feasibility rates were calculated for screw diameters between 2.75 mm and 4.00 mm. The effects of age and gender were also analyzed. Results: The fourth metacarpal had the smallest mean isthmus diameter (2.64 ± 0.89 mm), while the fifth had the largest (3.21 ± 0.84 mm). Feasibility decreased as screw diameter increased across all metacarpals. The fourth metacarpal showed the lowest compatibility, with feasibility rates of 10.7% for 3.5 mm screws and 4.0% for 4.0 mm screws. In contrast, the fifth metacarpal had the highest feasibility at smaller diameters, with 74.7% compatibility for 2.75 mm screws and 62.7% for 3.0 mm screws. Positive correlations were found between age and isthmus diameters of the second and third metacarpals, indicating age-related canal widening. Conclusions: The anatomical feasibility of IMHS fixation in the second to fifth metacarpals is influenced by isthmus morphology. The fourth metacarpal appears to be the most restrictive, particularly for screws ≥ 3.5 mm. These findings support individualized CT-based preoperative templating rather than standardized implant selection to improve screw canal compatibility and reduce cortical compromise risk.