Sagittal Band Disruption Following Percutaneous Retrograde Intramedullary Screw Fixation of a Metacarpal Shaft Fracture: A Case Report

Abstract

Metacarpal fractures may be managed operatively or non-operatively, with malrotation being an indication for operative management. High rates of stiffness have been reported following operative management of metacarpal fractures, and intramedullary screw fixation is a widely accepted treatment that allows early range of motion to help prevent stiffness. While there are some known complications of this treatment modality, there are limited reports of sagittal band disruption. We report the case of a man who presented with sagittal band disruption and ulnar deviation following percutaneous retrograde intramedullary screw fixation of a metacarpal shaft fracture. This report includes details of the patient's injury, treatment, complication, and follow-up, and urges the awareness of the complication and a reconsideration in the fixation approach and technique.

Keywords: hand and wrist surgery; hand trauma surgery; metacarpal fractures; retrograde screw fixation; sagittal band ruptures.

Figure 1. Patient imaging: (A) PA radiograph of the left hand demonstrating percutaneous screw fixation of the third metacarpal. (B) MRI of the left hand demonstrated concern for radial sagittal band disruption and (C) ulnar translation of the extensor tendon of the finger.