title: Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures.
abstract: OBJECTIVE
  To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures.
  
  
  METHODS
  Retrospective review of prospectively collected data on a consecutive series of 39 patients (34 men; 5 women), mean age 28 years (range, 16-66 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N = 26) and shaft (N = 13) fractures at a single academic practice between 2010 and 2014. Preoperative magnitude of metacarpal neck angulation averaged 54° (range, 15° to 70°), and shaft angulation averaged 38° (range, 0° to 55°). Patients used a hand-based orthosis until suture removal and began active motion within the first week. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis was assessed. Twenty patients reached minimum 3-month follow-up, with a mean of 13 months (range, 3-33 mo).
  
  
  RESULTS
  All 20 patients with minimum 3 months of follow-up achieved full composite flexion, and extensor lag resolved by 3-week follow-up. All patients demonstrated full active metacarpophalangeal joint extension or hyperextension. Grip strength measured 105% (range, 58% to 230%) of the contralateral hand. No secondary surgeries were performed. There were 2 cases of shaft re-fracture from blunt trauma following prior evidence of full osseous union with the screw in place. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported occasional clicking with metacarpophalangeal joint motion not requiring further treatment.
  
  
  CONCLUSIONS
  Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages in select patients.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA. Electronic address: druchelsman@mgh.harvard.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Ruchelsman
authors.affiliation: Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Puri
authors.affiliation: Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
authors.forename: Natanya
authors.initials: N
authors.lastname: Feinberg-Zadek
authors.affiliation: Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Leibman
authors.affiliation: Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Belsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Metacarpal fracture; clinical outcomes; hand trauma; headless screw; intramedullary fixation; minimally invasive surgery