title: Systematic review of the best evidence in intramedullary fixation for metacarpal fractures.
abstract: BACKGROUND
  Intramedullary (IM) fixation has been described as a reliable method of treatment for certain fracture patterns but has not been widely adopted into practice. The purpose of this study was to evaluate the literature comparing IM fixation to other forms of treatment for metacarpal fractures.
  
  
  METHODS
  A systematic review was performed to identify studies investigating the treatment of metacarpal fractures using IM fixation. Inclusion and exclusion criteria were predetermined. Two reviewers independently identified appropriate articles for review based on the criteria. Primary outcome measures were range of motion (ROM) (Styf et al., Rev Chir Orthop Reparatrice Appar Mot 74(Suppl 2):268-270, 2008) and complications. Secondary outcomes included loss of reduction, grip strength, Disabilities of arm, shoulder and hand (DASH) scores, radiographic measures and pain scores.
  
  
  RESULTS
  Eight studies were eligible for review. Studies were of level II-IV evidence, and captured a total of 435 patients. The ROM post-operatively was found to be greater in the IM group in half of the studies. IM fixation trended toward higher complication rates in one study, but no differences were statistically significant. IM fixation fared similarly or superiorly to its competitor in each of the secondary outcomes. A formal meta-regression analysis was not possible given the heterogeneity of studies.
  
  
  CONCLUSIONS
  IM fixation may have a role in the treatment of certain metacarpal fractures. No conclusive recommendations can be made based on the available studies included in this literature search. Further study of this technique and its applications using high level evidence is warranted.
authors.affiliation: Dalhousie University, Halifax, NS B3H4R2, Canada.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Corkum
authors.affiliation: Plastic Surgery Department, Dalhousie University, C204 - 600 Main St Saint John, Saint John, NB E2K 1J5 Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davison
authors.affiliation: Plastic Surgery Department, Dalhousie University, Hilyard Place, Suite C204 600 Main St, Saint John, NB E2K 1J5 Canada.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lalonde
keywords: Intramedullary fixation; Metacarpal fractures; Systematic review