S. Kalra1, A. Seibel1, M. Akhtar1, A. Wadhawan1, E. Frezza1 1California Northstate University, College Of Medicine, Elk Grove, CA, USA
Introduction:
Metacarpal and phalangeal fractures are common fractures of the upper extremities; displaced or unstable fractures require operation and are often treated with Kirschner wires (K-wires), plate and screw constructs, and intramedullary rods or nails. However, these techniques have been associated with lengthy immobilization or recovery times, extensive dissection, and high rates of infections or revision surgeries. Intramedullary headless compression screw fixation is a minimally invasive procedure that does not require postoperative immobilization; this technique has been widely used for scaphoid fractures but is relatively newer in other hand bones. The purpose of this systematic review was to further elucidate the merits of intramedullary headless compression screw fixation by analyzing clinical, functional, radiographic, and patient-reported outcomes, complications, and secondary surgery rates after metacarpal and phalangeal fractures.
Methods:
A search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted in the PubMed, Embase, and Cochrane Library databases in June 2024. Studies which evaluated outcomes or complications after intramedullary headless compression screw fixation of metacarpal or phalangeal fractures, or both, were included. Data regarding study characteristics, patient demographics, clinical outcomes, patient-reported outcomes, complications, and secondary surgeries were collected.
Results:
Fifteen studies involved 517 patients: twelve studies evaluated 427 patients with metacarpal fractures and five studies evaluated 90 patients with phalangeal fractures. The mean postoperative QuickDASH score ranged from 4.8 to 8.23 for metacarpal fractures and 3.2 to 5.13 for phalangeal fractures. Six metacarpal fracture studies reported the total active ROM (TAM), which was >240° in two studies and ranged from 237.7° to 249° in the remaining four studies. Five phalangeal fracture studies reported the TAM, which ranged from 222° to 258°. Nine metacarpal and two phalangeal fracture studies achieved 100% radiographic union by the latest follow-up; seven metacarpal and three phalangeal fracture studies achieved 100% return to activity in the same timeframe. The collective complication and revision rates were 3.4% and 2.6% respectively for metacarpal fractures, and 8.2% and 9.6% for phalangeal fractures.
Conclusion:
Intramedullary headless compression screw fixation of metacarpal and phalangeal fractures demonstrates excellent short-term outcomes; mean QuickDASH scores were less than the United States’ general population’s benchmark value of 10 and patients demonstrated adequate ROM, achieved radiographic union, and returned to previous activity. Screw fixation complication and secondary surgery rates were lower than the previously reported values for K-wires and open reduction and internal fixation (ORIF) with plate and screw constructs.