To compare the clinical and radiographic outcomes of intramedullary nail (IMN) fixation
of metacarpal fractures with those of plate-screw (PS) fixation.
Between 2004 and 2006, we treated 52 consecutive closed, displaced, extra-articular
metacarpal fractures operatively using 1 of 2 fixation methods: IMN or PS. Patient
characteristics, mechanism of injury, pattern of fracture, and preoperative radiographic
parameters were similar in both groups. The outcome measures were collected and analyzed:total
active motion of the digit and Disabilities of the Arm, Shoulder, and Hand score and
radiographic parameters.
Thirty-eight patients received IMN fixation and 14 patients received PS fixation.
Mean follow-up time was 18 weeks in the IMN group and 19 weeks in the PS group. The
mean and median total active motion were 237 degrees and 250 degrees for the IMN group,
228 degrees and 248 degrees for the PS group, with no statistically significant difference
between the groups. The mean Disabilities of the Arm, Shoulder, and Hand score was
9.47 in the IMN group and 8.07 in the PS group. The association between hardware type
and fracture location (middle or distal third of metacarpal) was not statistically
significant. Time to radiographic healing also did not reach statistical significance
between groups. Operative time was significantly shorter with use of the metacarpal
nail. Five patients in the IMN group displayed loss of reduction; no failure was observed
in the PS group.
There were no significant differences in the clinical outcomes using either technique.
Although operative time was shorter in the IMN group than in the PS group, the incidences
of loss of reduction, penetration to the metacarpal-phalangeal joint, and secondary
surgeries for hardware removal in the operating room were much higher in the IMN group.
Therapeutic III.