Abstract
Metacarpal fractures constitute 7.8% of the upper extremity fractures. The common
treatments remain nonsurgical procedure, but high-demanding patients or unstable fractures
require fixation with Kirschner wire (K-wires), plate, and screws. However, these
approaches may cause scarring and adhesion with poor functional results. From 2014
to 2015, the authors used an intramedullary headless screw to treat 25 patients (24
men, 1 woman) with metacarpal bones fractures (20 V, 3 IV, 1 III, and 1 II). The fractures
patterns were 23 fractures of distal third of metacarpal bone (16 oblique, 5 comminute
configurations, and 2 transverse), 1 fracture of the base of the II metacarpal bone.
One case presented a multiple metacarpal and phalangeal facture associated. The authors
used wide-awake anesthesia (bupivacaine-epinephrine 1:100,000) and intramedullary titanium headless
screw fixation percutaneously inserted (CCS Medartis and HCS Synthes 3 mm of diameter).
No open reduction was needed. Early active mobilization started with a buddy strapping
soon after surgery (0–3 days). The authors followed all patients until satisfactory
function was achieved (4–6 weeks) and recorded the time till return to work. All fracture
healed with less than 5 degrees of rotational or axial deformities. All patients return
to work within 2.38 weeks after surgery (0.5–6 weeks). No cases of complex regional
pain syndrome (CRPS), tendon lesions, nerve injuries, infection, hardware protruding,
or mobilization were reported. Intramedullary screw fixation with wide-awake anesthesia for transverse, oblique, and select comminuted fractures treatment metacarpal
fractures represent a reliable option to early active mobilization recovery and a
quick return to the work and ordinary activities.
Keywords
metacarpal factures - intramedullary fixation - headless screws -
wide-awake anesthesia
