Nonsurgical Treatment Versus Intramedullary Fixation of Displaced Metacarpal Shaft Fractures.

Abstract

Purpose: Retrograde intramedullary headless compression screw (IMHS) fixation offers potential advantages over traditional surgical treatment of metacarpal shaft fractures. The purpose of this study was to compare the rates of recovery of short-term functional outcomes for displaced metacarpal shaft fractures treated nonsurgically and those treated using a minimally invasive intramedullary screw technique. We hypothesized that IMHS fixation would lead to earlier return of function with equivalent outcomes at final follow-up.

Methods: We identified patients between 2017 and 2022 with a displaced metacarpal shaft fracture treated nonsurgically or with IMHS. We included patients aged 18-65 years with a minimum 12 week follow up. We excluded open fractures and those presenting >1 week from injury. We documented radiographic displacement, grip strength, visual analog scale pain scores, total active motion (TAM), return to work (RTW), time to union, complications, and treatment cost. We performed a linear regression analysis to compare outcomes over time and survival curves for RTW.

Results: Ninety-nine patients with 109 fractures were included. Intramedullary headless compression screw fixation demonstrated less radiographic shortening (2.4 vs 5.1 mm) and angulation at 12 weeks (2° vs 30°) compared with nonsurgical management. There was significantly faster normalization of grip strength in the IMHS group during the first 6 weeks. At 12 weeks, there was no significant difference between the IMHS and nonsurgical groups in TAM, pain, or grip strength. The IMHS group had faster return to light (1.2 vs 2.1 weeks) and heavy-duty work (3.1 vs 6.1 weeks). Average direct cost was $1,413 and $2,452 for nonsurgical and IMHS patients, respectively.

Conclusions: The IMHS group demonstrated earlier return of grip strength and RTW compared with nonsurgical treatment. Intramedullary headless compression screw fixation improved radiographic parameters at 12 weeks without a difference in TAM, grip strength, or visual analog scale pain scores. The direct cost was higher by $1,039 with IMHS fixation.

Level of evidence: Therapeutic IV.