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. 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. 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.
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.
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.
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