Fixation Strategies for Metacarpal Shaft Fractures: A Comparison of Plate-and-Screw, Intramedullary Screw, and Percutaneous Wire Techniques.

PURPOSE: The optimal fixation for metacarpal shaft fractures remains a topic of debate. This study compares clinical outcomes of three fixation methods-closed reduction with percutaneous Kirschner wire pinning, open reduction internal fixation (ORIF), and intramedullary fixation (IMN)-focusing on time to motion, range of motion (ROM), and complications. We hypothesized that IMN would allow earlier and more reliable return of ROM without increasing complications.

METHODS

A retrospective review of 84 patients (104 diaphyseal fractures) treated at a level I trauma center between 2018 and 2024 was performed. Patients undergoing nonoperative treatment, multiple fixation methods, or requiring nerve/vascular repair were excluded. Demographic, injury, surgical, and follow-up data were collected. Postoperative motion initiation and complete ROM data, time to union, complications, and reoperation rates were analyzed; multivariate analyses controlled for patient and fracture characteristics. Statistical significance was set at P < .05.

RESULTS

IMN and ORIF achieved faster initiation of motion (IMN: 16 days [interquartile range, 11-19]; ORIF: 14 days [interquartile range, 12-22]) compared with closed reduction with percutaneous Kirschner wire pinning (33 days [27-39]). IMN fixation had faster return to full ROM (37 days [26-48]) compared with both ORIF (44 [33-81]) and closed reduction with percutaneous Kirschner wire pinning (114 [70-151]) (P < .001). IMN patients were more likely to achieve full ROM at final follow-up than ORIF patients (odds ratio: 12.3, 95% CI: 2.1-73.5). Complication and union rates were similar among the groups.

CONCLUSIONS

IMN provides robust, minimally invasive fixation enabling early and reliable return of full ROM while maintaining low complication rates. These results support IMN as the optimal fixation method for appropriately selected metacarpal shaft fractures.

TYPE OF STUDY/LEVEL OF EVIDENCE: Level III (retrospective cohort study Therapeutic III.