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J Wrist Surg 2024; 13(01): 054-057
DOI: 10.1055/s-0042-1758705
Scientific article

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

Stephanie A. Kwan 
1   Department of Orthopaedic Surgery, Rowan University SOM, Stratford, New Jersey
,
William L. Wang
2   Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Jacob E. Tulipan
3   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Amir Kachooei
3   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Pedro K. Beredjiklian
3   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
,
Michael Rivlin
3   Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All implants used were donated for the study and there was no financial conflict.
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Abstract

Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal.

Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals.

Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured.

Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site.

Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment.

Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.

Keywords

metacarpal - fracture - treatment - intramedullary screw

Note

This study was reviewed and approved by the Institutional Review Board at Thomas Jefferson University.




Publication History

Received: 08 June 2022

Accepted: 11 October 2022

Article published online:
28 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013; 38 (05) 1021-1031 , quiz 1031
    CrossrefPubMedGoogle Scholar
  • 2 Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin 2013; 29 (04) 507-518
    CrossrefPubMedGoogle Scholar
  • 3 Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y) 2014; 9 (01) 16-23
    CrossrefPubMedGoogle Scholar
  • 4 Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am 1985; 10 (04) 466-472
    CrossrefPubMedGoogle Scholar
  • 5 Greeven APA, Bezstarosti S, Krijnen P, Schipper IB. Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review. Eur J Trauma Emerg Surg 2016; 42 (02) 169-175
    CrossrefPubMedGoogle Scholar
  • 6 Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg [Br] 2006; 31 (01) 61-65
    CrossrefPubMedGoogle Scholar
  • 7 Dreyfuss D, Allon R, Izacson N, Hutt D. A comparison of locking plates and intramedullary pinning for fixation of metacarpal shaft fractures. Hand (N Y) 2019; 14 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 8 Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014; 39 (12) 2390-2395
    CrossrefPubMedGoogle Scholar
  • 9 Warrender WJ, Ruchelsman DE, Livesey MG, Mudgal CS, Rivlin M. Low rate of complications following intramedullary headless compression screw fixation of metacarpal fractures. Hand (N Y) 2020; 15 (06) 798-804
    CrossrefPubMedGoogle Scholar
  • 10 Jones CM, Padegimas EM, Weikert N, Greulich S, Ilyas AM, Siegler S. Headless screw fixation of metacarpal neck fractures: a mechanical comparative analysis. Hand (N Y) 2019; 14 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 11 Dyrna FGE, Avery III DM, Yoshida R. et al. Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws. BMC Musculoskelet Disord 2021; 22 (01) 335
    CrossrefPubMedGoogle Scholar
  • 12 Okoli M, Lutsky K, Rivlin M, Katt B, Beredjiklian P. Metacarpal bony dimensions related to headless compression screw sizes. J Hand Microsurg 2020; 12 (1, Suppl 1): S39-S44
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015; 40 (04) 692-700
    CrossrefPubMedGoogle Scholar
  • 14 Guidi M, Frueh FS, Besmens I, Calcagni M. Intramedullary compression screw fixation of metacarpal and phalangeal fractures. EFORT Open Rev 2020; 5 (10) 624-629
    CrossrefPubMedGoogle Scholar
  • 15 Roebke AJ, Roebke LJ, Goyal KS. Fracture gap reduction with variable-pitch headless screws. J Hand Surg Am 2018; 43 (04) 385.e1-385.e8
    CrossrefPubMedGoogle Scholar
  • 16 Lin CC, Lin KP, Huang CC. et al. Partially threaded headless screw may benefit adequate interfragmentary compression and reduced driving torque for small bone fixation. J Orthop Surg (Hong Kong) 2018; 26 (01) 1-6
    PubMedGoogle Scholar
  • 17 Wheeler DL, McLoughlin SW. Biomechanical assessment of compression screws. Clin Orthop Relat Res 1998; (350) 237-245
    PubMedGoogle Scholar
  • 18 Magee W, Hettwer W, Badra M, Bay B, Hart R. Biomechanical comparison of a fully threaded, variable pitch screw and a partially threaded lag screw for internal fixation of type II dens fractures. Spine 2007; 32 (17) E475-E479
    CrossrefPubMedGoogle Scholar
  • 19 Mudgal CS, Jupiter JB. Plate and screw design in fractures of the hand and wrist. Clin Orthop Relat Res 2006; 445 (445) 68-80
    CrossrefPubMedGoogle Scholar
  • 20 Ahmed U, Malik S, David M, Simpson C, Tan S, Power D. The headless compression screw - technical challenges in scaphoid fracture fixation. J Orthop 2015; 12 (Suppl. 02) S211-S216
    CrossrefPubMedGoogle Scholar
  • 21 Carreño A, Ansari MT, Malhotra R. Management of metacarpal fractures. J Clin Orthop Trauma 2020; 11 (04) 554-561
    CrossrefPubMedGoogle Scholar
  • 22 Strauch RJ, Rosenwasser MP, Lunt JG. Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am 1998; 23 (03) 519-523
    CrossrefPubMedGoogle Scholar
  • 23 Urbanschitz L, Dreu M, Wagner J, Kaufmann R, Jeserschek JM, Borbas P. Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures. J Hand Surg Eur Vol 2020; 45 (06) 601-607
    CrossrefPubMedGoogle Scholar
  • 24 Okoli M, Chatterji R, Ilyas A, Kirkpatrick W, Abboudi J, Jones CM. Intramedullary headless screw fixation of metacarpal fractures: a radiographic analysis for optimal screw choice. Hand (N Y) 2022; 17 (02) 245-253
    CrossrefPubMedGoogle Scholar
  • 25 Patel S, Giugale JM, Debski RE, Fowler JR. Effect of screw length and geometry on interfragmentary compression in a simulated proximal pole scaphoid fracture model. Hand (N Y) 2020; 15 (03) 378-383
    CrossrefPubMedGoogle Scholar