Intramedullary Headless Screw Fixation of Distal Metacarpal Fractures - the Birmingham Experience.

Surgical fixation using intramedullary headless screws (IHS) is a relatively new technique for metacarpal fracture repair. However, there are very few studies investigating the outcomes of this procedure. We present the surgical and functional outcomes of a consecutive series of 30 metacarpal fractures treated by a single surgeon over a 2.5-year period using IHS. We retrospectively reviewed the records of 30 metacarpal fractures in 27 patients who underwent IHS fixation from March 2016 to October 2018. There were 29 fractures of the metacarpal neck and 1 was to the metacarpal head. All fractures underwent the procedure by a single operating surgeon. Individual joint movements along with total active movement (TAM) was measured at postoperative follow-up appointments 4-8 weeks after surgery. Fracture healing was confirmed with plain radio-graphs. Patients were also recalled in March 2019 for their latest functional measurements. A QuickDASH (disabilities of the arm, shoulder and hand) questionnaire was used to assess for any residual functional disability. All fractures healed within acceptable radiological parameters with no mal-unions or rotational deformities. The average TAM at initial follow-up was 245°, which improved to 264° at the March 2019 review. All patients returned to work in an average of 6 weeks. The final functional QuickDASH score was an average of 2.9/100 (range 0-18.2). 2/27 patients required further surgery for stiffness before regaining excellent TAM. No patient required metalwork removal. There were no other complications. Our findings suggest that IHS fixation is an effective alternative technique for the treatment of metacarpal fractures. It is a relatively simple procedure, which provides good stable fixation, allowing for early mobilisation. It has few complications and does not routinely require removal of the implant