Purpose
Retrograde headless compression screw (RHCS) fixation for metacarpal fractures can
lead to metacarpal head articular cartilage violation. This study aimed to quantify
the articular surface loss after insertion of the RHCS and determine the functional
range of motion (ROM) of the metacarpophalangeal (MCP) joint at the point of contact
between the proximal phalangeal (P1) base and the articular defect.
Methods
Ten fresh-frozen cadaveric hand specimens were analyzed for prefixation MCP joint
ROM. After screw insertion, the ROM at which the dorsal portion of the P1 base begins
to engage the screw tract defect, as well as the ROM at which the midsagittal portion
of the P1 bisector engages the screw tract defect, was recorded. The distal axial
articular surface of the metacarpal and the defects from screw insertion were measured
using a digital image software program.
Results
Nine men and one woman (mean age, 69 years) were examined. The prefixation mean extension-flexion
arc for all MCP joints ranged from 1° to 85°. After screw insertion, the mean MCP
ROM at which the dorsal P1 articular surface first engaged the screw tract was 31°.
Only 7 digits had screw tract engagement with the midsagittal bisector of the P1 base
at a mean flexion angle of −18° (18° hyperextension). Mean articular surface violation
increased from the index finger moving ulnarly, with an average of 3.9% involvement.
Conclusions
Articular surface loss of the metacarpal head following RHCS insertion is negligible
in a cadaveric model, with minimal engagement between the corresponding defect and
the P1 base during functional ROM.
Clinical relevance
Retrograde headless compression screw fixation of metacarpals inevitably damages the
cartilage. However, the actual defect is small in proportion to the articular surface
area and not engaged during functional activity. These biomechanical features may mitigate
the surgeon’s concern about joint destruction, while ensuring the benefits of early
rehabilitation and minimal invasiveness of this technique.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical outcomes of limited open intramedullary headless screw fixation of metacarpal fractures in 91 consecutive patients.Hand (N Y). 2019; 00: 1-5
- The frequency and epidemiology of hand and forearm fractures in the United States.J Hand Surg Am. 2001; 26: 908-915
- Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results.Hand (N Y). 2015; 10: 314-318
- Analysis of 3 different operative techniques for extra-articular fractures of the phalanges and metacarpals.Hand (N Y). 2019; 00: 1-9
- Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws.J Hand Surg Am. 2015; 40: 692-700
- Extraarticular hand fractures in adults: a review of new developments.Clin Orthop Relat Res. 2006; 445: 133-145
- Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report.J Hand Surg Am. 2010; 35: 1260-1263
- Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures.J Hand Surg Am. 2014; 39: 2390-2395
- Headless screw fixation of metacarpal neck fractures: a mechanical comparative analysis.Hand (N Y). 2019; 14: 187-192
- Fixation of metacarpal shaft fractures: biomechanical comparison of intramedullary nail crossed k-wires and plate-screw constructs.Orthop Surg. 2015; 7: 256-260
- Malunion and nonunion of the metacarpals and phalanges.Journal of Bone and Joint Surgery. 2005; 87: 1380-1388
- Complications after the fractures of metacarpal and phalanges.Hand Clin. 2010; 26: 169-177
- Low rate of complications following intramedullary headless compression screw fixation of metacarpal fractures.Hand (N Y). 2019; 00: 1-7
- Complications of K-wire fixation in procedures involving the hand and wrist.J Hand Surg Am. 2011; 36: 610-616
- Complications of K-wire fixation of fractures and dislocations in the hand and wrist.Arch Orthop Trauma Surg. 2001; 121: 527-530
- Intramedullary fixation of metacarpal fractures using headless compression screws.J Hand Microsurg. 2016; 8: 134-139
- Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws.Hand Surg Rehabil. 2018; 37: 99-103
- Fixation of metacarpal fractures using intramedullary headless compression screws: a tertiary care institution experience.Cureus. 2019; 11e4466
- Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures.J Hand Surg Am. 2013; 38: 322-330 e322
- Evaluation of antegrade intramedullary compression screw fixation of metacarpal shaft fractures in a cadaver model.J Hand Surg Am. 2021; 46: e1-e7
- Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study.J Hand Surg Eur Vol. 2016; 41: 683-687
- Management of intra-articular metacarpal base fractures of the second through fifth metacarpals.J Hand Surg Am. 2008; 33: 573-583
- Functional range of motion in the metacarpophalangeal joints of the hand measured by single axis electric goniometers.J Orthop Sci. 2018; 23: 504-510
- An anatomical study of metacarpal morphology utilizing CT scans: evaluating parameters for antegrade intramedullary compression screw fixation of metacarpal fractures.J Hand Surg Am. 2021; 46: 149 e141-149 e148
- Morphological analysis of metacarpal shafts with respect to retrograde intramedullary headless screw fixation.Hand (N Y). 2020; 00: 1-7
Article info
Publication history
Published online: July 19, 2022
Accepted:
May 18,
2022
Received:
July 19,
2021
Publication stage
In Press Corrected ProofFootnotes
TriMed Inc (Santa Clarita, CA) supplied cadaver specimens and hardware for use during this research.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
