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Intramedullary Headless Screw Fixation of Metacarpal Fractures: A Radiographic Analysis for Optimal Screw Choice
Journal article   Open access   Peer reviewed

Intramedullary Headless Screw Fixation of Metacarpal Fractures: A Radiographic Analysis for Optimal Screw Choice

Michael Okoli, Rishi Chatterji, Asif Ilyas, William Kirkpatrick, Jack Abboudi and Christopher M Jones
Hand (New York, N.Y.), v 17(2), pp 245-253
01 Mar 2022
DOI: https://doi.org/10.1177/1558944720919897
PMID: 32432499
url
https://doi.org/10.1177/1558944720919897View
Published, Version of Record (VoR) Open

Abstract

Bone Screws Fracture Fixation, Internal - methods Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Hand Injuries Humans Metacarpal Bones - diagnostic imaging Metacarpal Bones - injuries Metacarpal Bones - surgery
The purpose of this study was to investigate variations in radiographic metacarpal anatomy as it relates to intramedullary (IM) fixation of metacarpal fractures and to compare this anatomy with available headless screw dimensions. We radiographically analyzed posteroanterior and lateral (LAT) radiographs of 120 metacarpals across 30 patients without structural abnormalities. Primary outcomes included IM isthmus diameter, isthmus location, metacarpal cascade, and head entry point collinear with IM canal. Measurements were compared with a list of commercially available headless screws used for IM fixation. The average largest isthmus diameter was in the small metacarpal (3.4 mm), followed by the index (2.8 mm), long (2.7 mm), and ring (2.7 mm) metacarpals. The average cascade angle between long and index, long and ring, and long and small metacarpals was 0°, 24°, and 27°, respectively. The appropriate head entry point ranged between 25% and 35% from the dorsal surface of the metacarpal head on a LAT view. The retrograde isthmus location of the index and long finger was 39.2 and 38.1 mm, respectively. Twenty-five screws from 7 manufacturers were analyzed with sizes ranging from 1.7 to 4.5 mm. Only 8 of 17 screws between 2.3 and 3.5 mm had a length range above 35 mm. Metacarpal head entry point and cascade angle can help identify the appropriate reduction with the guide pin starting point in the dorsal 25% to 35% of the metacarpal head. Surgeons should be mindful to choose the appropriate fixation system in light of the variations between metacarpal isthmus size, isthmus location, and available screw lengths.

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11 citations in Web of Science
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Collaboration types
Domestic collaboration
Web of Science research areas
Orthopedics
Surgery
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