By Marissa R. Matarrese, MD

Tucked away in the northernmost corner of New York is a small town nestled on the shores of Lake Champlain. I started practicing here almost five years ago; it is my first job after fellowship. My fellow inhabitants are working-class people, many whom are farmers or factory workers. They, like so many Americans, live paycheck to paycheck and can’t afford time out of work. “Light duty” isn’t an option with many of the employers. These are only some of the reasons it is challenging to manage a straight-forward problem: the metacarpal fracture. Until a few months ago, I treated these in a rather standard fashion, casting or percutaneously pinning most of them for a few weeks, followed by a referral to hand therapy for fabrication of a removable splint, range of motion and eventually strengthening. Patients get so stiff in their cast and it is not infrequently that they are out of work for five weeks or more.

Now, I do things differently. I rarely adopt new products right out of the gate, having been appropriately cautioned about doing so by a mentor in residency that learned the hard way. But then this past fall, I was walking through the exhibit hall at ASSH staring at the same exhibitors all selling slightly different versions of the same solutions to the same problems when a new exhibitor caught my eye: ExsoMed. On display inside a plexiglass hand was a potential solution to my problem: the INnate implant, an intramedullary threaded nail sized specifically for the metacarpal. I chatted with the surgeons who developed the product and started to get excited: if I could get percutaneous stable internal fixation, I could potentially get my patients back to work much faster. I had the opportunity to place some of the first screws to hit the shelves and I have been nothing but impressed. I now give patients their options: treat this with a cast, probably five weeks out of work, deal with stiffness, soreness and the standard list of complaints or go to the operating room for a procedure that takes about five minutes longer to do than percutaneous pinning. There’s really no learning curve, since the screw is placed similarly to a headless cannulated screw. One week post-operatively, I get them to the therapist for range of motion and then I let them start doing heavy activities as soon as they are comfortable. Most have asked to return to work two to three weeks post-operatively. I have even had a gymnast start weight-bearing three weeks post-operatively.

I’m excited with these positive early patient results! I look forward to seeing future studies and hearing feedback from other surgeons who are also adopting this solution. In my experience, the INnate implant is the most minimally invasive solution to achieving rigid fixation of a metacarpal fracture and is allowing my patients earlier return to full activity.

 

*Disclosure: Dr. Matarrese has recently started consulting for ExsoMed but did not receive any financial compensation for this contribution.