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

Q3 What are Important Preoperative and Postoperative Considerations?

The key to successful IMF is selection of the screw to be used preoperatively based on radiographs of the hand. The metacarpal length and inner diameter of isthmus (most narrow portion) are measured on posteroanterior view in millimeters. The surgeon should be mindful that each metacarpal has consistent differences in width, as the ring finger has the narrowest isthmus at average of 2.6 mm and small finger largest at 3.6 mm. The width of the narrowest part of the isthmus is the most important factor to guide the choice of the appropriately sized screw to ensure contact between screw and bone without causing blowout. Screw length is recommended to be at least 4–6 mm shorter than full bone length. Measurements of the K-wire are performed, and 4–6 mm are generally subtracted to get final screw length (for partially threaded screws, measurements must accommodate for the distal threads to be placed past the fracture line).

A bulky soft dressing is placed immediately postoperative and removed between 3–5 day for early range of motion to begin. There is no need for rigid immobilization if good purchase is achieved. The patient is expected to reach full range of motion by 4 weeks and start strengthening and progressively heavier activities in 4–8 weeks. Unlimited unrestricted usage is recommended by 8 weeks.