Intramedullary Headless Compression Screw Fixation Technique of Metacarpal Fractures

John Chao, MD; Steven Cai, MD; Mark Granick, MD


ePlasty. 2022;22(ic2) 

In This Article

Q1 What are the Indication, Alternatives, and Benefits of Intramedullary Screw Fixation?

Metacarpal fractures can be fixated with K-wire, plating, and IMF. K-wires have the benefit of low cost and speed but comes at great cost of joint stiffness as wires prevent early joint motion post-operatively, risk of infection, and require patient compliance in removal and hand therapy.[1] Plating has the benefit of stable fixation allowing early range of motion at the expense of more extensive soft tissue dissection, surgery duration, and increased cost.[2] IMF has the benefits of minimal incision, stable fixation to allow early range of motion, limited reliance on non-cooperative patients, and shortened duration of surgery.[3]

IMF screws are designed to be compressive and non-compressive due to its variable threaded and fully threaded construct, respectively. In transverse fractures and short oblique fractures (< 2 times the shaft diameter), the compression screws are indicated. Fully threaded screws are useful for comminuted and long oblique fractures (>2 times the shaft diameter) because metacarpal shortening and fracture fragment migration is avoided secondary to compression.[4]

Contraindications to IMF screws include patients with head-splitting fractures due to the risk of worsening the fracture with placement of the screw. Infected and pediatric fractures with open physes are also absolute contraindications.[5]