There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures.
A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data.
Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery.
Complications following IMS fixation of metacarpal fractures are relatively uncommon.
Type of study/level of evidence
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 access
One-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 Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Incidence of metacarpal fractures in the US population.Hand (N Y). 2012; 7: 426-430
- Current management of metacarpal fractures.Hand Clin. 2013; 29: 507-518
- Hand fractures: Indications, the tried and true and new innovations.J Hand Surg Am. 2016; 41: 712-722
- Metacarpal neck fractures: A review of surgical indications and techniques.Arch Trauma Res. 2016; 5e32933
- Intramedullary K-wires versus alternate techniques for metacarpal shaft and neck fractures: A systematic review and meta-analysis.J Hand Microsurg. 2022; (eFirst)
- Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report.J Hand Surg Am. 2010; 35: 1260-1263
- Intramedullary screw fixation of metacarpal and phalangeal fractures–A systematic review of 837 patients.Hand Surg Rehabil. 2021; 40: 622-630
- Intramedullary screw fixation comprehensive technique guide for metacarpal and phalanx fractures: Pearls and pitfalls.Plast Reconstr Surg Glob Open. 2021; 9e3895
- Retrograde intramedullary screw fixation for metacarpal fractures: A systematic review.Hand (N Y). 2023; 18: 67-73
- Intramedullary screw fixation of metacarpal fractures results in excellent functional outcomes: A literature review.Plast Reconstr Surg. 2019; 143: 1111-1118
- The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
- RoB 2: A revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898
- ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions.BMJ. 2016; 355: i4919
- A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures.J Hand Surg Eur Vol. 2022; 47: 179-185
- Intramedullary screws versus Kirschner wires for metacarpal fixation, functional, and patient-related outcomes.Surg J (N Y). 2018; 4: e29-e33
- Intramedullary fixation with headless screws versus bouquet in unstable metacarpal neck fractures in active patients: A randomized study.Rev Bras Ortop (Sao Paulo). 2021; 56: 717-725
- Intramedullary percutaneous fixation of metacarpal fractures: Screw versus connected K-wires.Eur J Orthop Surg Traumatol. 2022; 32: 427-436
- Analysis of 3 different operative techniques for extra-articular fractures of the phalanges and metacarpals.Hand (N Y). 2021; 16: 595-603
- Cost comparison of Kirschner wire versus intramedullary screw fixation of metacarpal and phalangeal fractures.Hand (N Y). 2021; 15589447211030690
- Intramedullary fixation of metacarpal fractures using headless compression screws.J Hand Microsurg. 2016; 8: 134-139
- Low rate of complications following intramedullary headless compression screw fixation of metacarpal fractures.Hand (N Y). 2020; 15: 798-804
- Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws.J Hand Surg Am. 2015; 40: 692-700
- Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures.J Hand Surg Am. 2014; 39: 2390-2395
- Intramedullary headless screw fixation for metacarpal fractures.Tech Hand Up Extrem Surg. 2020; 25: 45-51
- Clinical outcomes of limited open intramedullary headless screw fixation of metacarpal fractures in 91 consecutive patients.Hand (N Y). 2020; 15: 793-797
- Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: Short term results.Hand (N Y). 2015; 10: 314-318
- Minimally invasive procedure for correcting extra-articular malunions of metacarpals and phalanges.J Hand Surg Am. 2022; (S0363-5023(21)00769-3)
- Percutaneous osteosynthesis with headless cannulated screws in the treatment of metacarpal and proximal and middle phalanxes fractures of the hand.Rev Iberoam Cir Mano. 2018; 46: 117-125
- Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up.J Hand Surg Eur Vol. 2021; 46: 466-470
- Percutaneous intramedullary headless screw fixation and wide-awake anesthesia to treat metacarpal fractures: Early results in 25 patients.J Hand Microsurg. 2018; 10: 16-21
- Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws.Hand Surg Rehabil. 2018; 37: 99-103
- Retrograde intramedullary headless compression screws for treatment of extra-articular thumb metacarpal base fractures.J Hand Surg Eur Vol. 2020; 45: 588-594
- Osteosynthesis of fractures of the metacarpal neck with self-compressing screw - Preliminary analysis of 21 cases.Rev Bras Ortop (Sao Paulo). 2021; 56: 198-204
- Intramedullary headless screw fixation of distal metacarpal fractures - The Birmingham experience.J Hand Surg Asian Pac Vol. 2021; 26: 52-59
- How to manage complications related to the use of intramedullary screws in metacarpal fractures: Case series.Rev Iberam Cir Mano. 2021; 49: 4-12
- Fixation of metacarpal fractures using intramedullary headless compression screws: A tertiary care institution experience.Cureus. 2019; 11e4466
- Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet.Hand Surg Rehabil. 2020; 39: 214-217
- Antegrade intramedullary screw fixation: A novel approach to metacarpal fractures.J Hand Surg Glob Online. 2019; 1: 229-235
- Percutaneous headless screws and wide-awake anesthesia to fix metacarpal and phalangeal fractures: Outcomes of the first 56 cases.J Biol Regul Homeost Agents. 2018; 32: 1569-1572
- Metacarpal shaft fixation: A biomechanical comparison of dorsal plating, lag screws, and headless compression screws.BMC Musculoskelet Disord. 2021; 22: 335
- Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures.J Hand Surg Am. 2013; 38: 322-330.e2
- Articular involvement with retrograde headless compression screw fixation of the metacarpal.J Hand Surg Am. 2022; (S0363-5023(22)00298-2)
- Metacarpal shaft fractures: The effect of shortening on the extensor tendon mechanism.J Hand Surg Am. 1998; 23: 519-523
- Brief communication: Operative fixation for distal radius fracture increases rates of trigger finger over a 6-month post-operative period.Orthop Res. 2020; 6
- Risk factors for carpal tunnel syndrome or trigger finger following distal radius fracture: A nationwide study.Sci Rep. 2020; 10: 469
Published online: March 04, 2023
Accepted: January 4, 2023
Received: August 30, 2022
Publication stageIn Press Corrected Proof
C.M.J. receives funding from ExsoMed. No benefits in any form have been received or will be received by the other authors related directly to this article.
© 2023 by the American Society for Surgery of the Hand. All rights reserved.