My New Go-To Fixation Technique
By Ryan D. Endress, MD
I’ve recently adopted the technique of cannulated intramedullary screws for metacarpal neck and shaft fractures. Depending on the fracture pattern, I would previously either perform percutaneous fixation with wires, or open fixation with plates and/or lag screws. I was looking for a way to provide the best of both worlds (i.e. less soft tissue dissection and scarring, with the stability to provide early mobilization). Initially I was hesitant given the theoretical risk of MCP joint arthritis, but after discussion with mentors about the dorsal location of the access point and evaluation of long term results my concerns were mitigated.
Thus far, I have been pleased with the ease of the procedure and the ability to move patients immediately and avoid postoperative stiffness. I feel they are less swollen and have less pain as well. For the right patient and fracture pattern, this has become my go-to fixation technique.