PURPOSE: To evaluate the clinical and radiological outcomes of a hybrid fixation technique combining intramedullary screw fixation with minimally invasive suture cerclage for the treatment of long-oblique and spiral metacarpal shaft fractures, patterns traditionally considered suboptimal for isolated intramedullary screw fixation.
METHODS: We conducted a retrospective analysis of 27 patients with closed long-oblique or spiral metacarpal shaft fractures treated between 2020 and 2024 using a hybrid technique consisting of a fully reamed retrograde cannulated screw and a double-stranded FiberLoop cerclage tied with a Nice knot. Functional outcomes included total active motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand, and visual analog scale for pain. Radiological union was assessed by computed tomography at 3 months. Complications were recorded prospectively.
RESULTS: All 27 patients achieved radiographic union within 3 months, with a mean trabecular bridging of 90.1% on computed tomography. Mean operative time was 45 minutes. At final follow-up (mean 14 months), mean total active motion of the affected digit was 166°, and grip strength recovered to 96.6% of the contralateral hand. Median Quick Disabilities of the Arm, Shoulder, and Hand score was 5; median visual analog scale was 0 at rest and during activity. No cases of implant failure, rotational deformity, or suture-related complications were observed. One patient developed mild scar tenderness that resolved spontaneously.
CONCLUSIONS: This hybrid technique appears safe and effective for unstable metacarpal shaft fractures not typically suited for standard intramedullary fixation. By integrating axial and rotational stability in a minimally invasive construct, the technique facilitates early motion and high union rates with minimal complications. These results support the extension of intramedullary fixation indications to more complex fracture patterns.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Read the article: PubMed · Publisher (DOI)