Purpose
Interest in intramedullary metacarpal fracture fixation (IMFF) with screws is increasing.
However, the optimal screw diameter for fracture fixation is not yet established.
In theory, larger screws should be more stable, but there is concern about long-term
sequelae of larger metacarpal head defects and extensor mechanism injury created during
insertion as well as implant cost. Therefore, the purpose of this study was to compare
different diameter screws for IMFF to a popular and more cost-effective alternative
of intramedullary wiring.
Methods
Thirty-two cadaveric metacarpals were used in a transverse metacarpal shaft fracture
model. Treatment groups consisted of IMFF with 3.0 × 60 mm, 3.5 x 60 mm, and 4.5 x
60 mm screws as well as 4 1.1-mm intramedullary wires. Cyclic cantilever bending was
performed with the metacarpals mounted at 45° to simulate physiologic loading. Cyclical
loading at 10, 20, and 30 N was performed to determine fracture displacement, stiffness,
and ultimate force.
Results
At 10, 20, and 30 N of cyclical loading, all screw diameters tested provided similar
stability as measured by fracture displacement and were superior to the wire group.
However, ultimate force under load to failure testing was similar between the 3.5-
and 4.5-mm screws and superior to 3.0-mm screws and wires.
Conclusions
For IMFF, 3.0, 3.5, and 4.5-mm diameter screws provide adequate stability for early
active motion and are superior to wires. When comparing the different screw diameters,
3.5- and 4.5-mm diameter screws offer similar construct stability and strength superior
to the 3.0-mm diameter screw. Therefore, to minimize metacarpal head morbidity, smaller
screw diameters may be preferable.
Clinical relevance
This study suggests that IMFF with screws is biomechanically superior to wires in
cantilever bending strength in the transverse fracture model. However, smaller screws
may be sufficient to permit early active motion while minimizing metacarpal head morbidity.
Key words
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Article info
Publication history
Published online: March 11, 2023
Accepted:
January 25,
2023
Received:
September 5,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly to this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
