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

Q4 What are Other Applications of IMF Screws in the Hand?

The use of compression screws has been well published in treating carpal bone fractures, especially the scaphoid.[6] Due to the compromised vascularity of the scaphoid proximal pole due to retrograde vascular anatomy, compression at the site of fracture is critical to prevent nonunion and avascular necrosis.[7] On the other hand, metacarpal and phalangeal bones have the ability to heal without need for compression by evidence of healing through hand splinting in minimally displaced fractures. Many studies have demonstrated excellent results in IMF of proximal and middle phalanx fractures.[8] IMF screws are a great option in phalanx fractures as PIPJ stiffness is a significant complication that can be avoided with early range of motion as part of this technique. Joint stiffness that results from K-wires can be debilitating to patients and require months of therapy to reverse, often with range of motion that is never at preoperative state.[9] In contrast to preoperative measurements of metacarpal bone on posteroanterior view, phalanx measurements should be done on lateral view. Anterograde screw placement is common with access through extensor hood and central slip for proximal and middle phalanxes, respectively.