Intramedullary screw fixation of ballistic metacarpal and phalanx fractures

Ballistic hand fractures present a complex problem for surgeons. Traditionally, these have been treated with K-wires, necessitating prolonged immobilization. While fixation of hand fractures using intramedullary (IM) screws has been shown to have excellent outcomes in blunt trauma, their use in ballistic fractures has not been well studied. Here, we report our early outcomes of fixation of ballistic hand fractures with IM screws.

Our retrospective study reviewed adult patients from March 2023 to August 2024 treated for ballistic hand fractures with IM screws. Demographic data, operative details, complications, and return to motion were recorded.

Thirty-two patients were included. The average age was 31.6 ± 14.0 years old, with the majority (29/32, 87.9%) being male. Most injuries involved the metacarpal and proximal phalanx, and 24/32 patients (75.0%) had intraarticular involvement. The average operative time was 75.9 min, including time required for other concurrent hand procedures in 19/32 (59.4%) of patients.The mean time from surgery to initiation of range of motion was 11.1 days, with 12/32 patients (37.5%) allowed to start range of motion immediately post-operatively. Time to full range of motion was 30.2 days and time to weightbearing was 51.6 days. Four patients (13.3%) had unplanned re-operations, all of which were due to proximal screw migration.

Our study demonstrates the feasibility of IM screw fixation of ballistic hand fractures. Our complication rate was minimal, and patients were able to safely return to normal activities of daily living at an accelerated pace.