Comparing Fixation Techniques in Metacarpal Fractures: Intramedullary Screw Versus Open Reduction Internal Fixation With Plate and Screw Construct.

Abstract

The purpose of this study is to compare intramedullary headless screw (IMN) versus plate and screw fixation (open reduction internal fixation [ORIF]) in metacarpal (MC) fractures, specifically looking at implant cost, operating room time, outcomes, and complications. We hypothesize that IMN will provide at least equivalent outcomes and complication rates compared with ORIF while simultaneously decreasing operating room time and lowering overall costs. Patients with MC fractures treated surgically at a single, level-one, trauma center between January 2018 and December 2022 were identified. Eighty-five patients and 108 fractures were included. Records were retrospectively reviewed for demographic information, injury data, surgical details, and follow-up information. The average age of included patients was 32.4 years. The leading causes of injury included altercations, falls, and motor vehicle collisions. Tourniquet time was an average of 79.9 minutes in the ORIF group and 37.6 minutes in the IMN group. Average cost of the implant and time to union were similar in both the groups. IMN fixation had faster time to motion and time to full range of motion. Complications, including revision surgery rates, wound infections, implant complications, and non/mal unions, were collected. Nine patients underwent revision surgery, eight in the ORIF group and one in the IMN group. Two superficial wound infections were noted in the ORIF group. One implant complication was observed in the ORIF group, as defined by implant breakage after the patient punched a wall. Three implant removals were noted, all in the ORIF group. In our experience, the use of an intramedullary screw for fixation of MC fractures is a reliable and safe method of fixation. The use of this procedure provides patients with quicker return to motion, faster time to full range of motion, and similar time to union with fewer complications. Furthermore, it resulted in decreased tourniquet time resulting in decreased overall cost. Retrospective review, Level III Therapeutic.