Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures

Abstract

Background: There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. Methods: We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Results: Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Conclusion: Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.

Keywords: fixation; fracture; headless compression screw; metacarpal; screw.

Figure 1.

(a) The injury film is shown. The index procedure was fixation of a fifth metacarpal shaft fracture with a headless compression screw, which successfully healed. (b and c) The fourth and fifth metacarpal were subsequently fractured due to postoperative blunt trauma. The screw was removed via the fracture site, and the joint was not opened. (d and e) Both fractures were repaired with a plate.

Figure 2.

(a) The index procedure was fixation of a second metacarpal shaft fracture with a headless compression screw, which successfully healed. (b and c) The metacarpal was subsequently reinjured. The screw was removed via the fracture site, and the joint was not opened. (d-f) The screw was converted to a plate.

Figure 3.

Radiographic appearance of a headless compression screw (a and b) prebending and (c and d) postbending. The patient was asymptomatic, and the screw was left in place. Courtesy of Chaitanya Mudgal, MD.