PURPOSE: The optimal surgical approach for retrograde intramedullary fixation (rIMF) of metacarpal fractures remains unclear. We hypothesized that a percutaneous approach for rIMF of metacarpal shaft fractures would exhibit improved functional outcomes compared to an open approach without increased incidence of extensor lag.
METHODS: A retrospective cohort of patients who sustained a closed metacarpal shaft fracture and underwent rIMF through either a percutaneous or an open approach were identified. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, total active motion (TAM), grip strength (% of contralateral) and visual analog scale pain scores were collected at 1, 2, 4, 6, and 12 weeks after surgery. Additional outcome measures included surgical time, radiographic alignment, and instances of extensor lag.
RESULTS: At a single level one trauma center, 54 patients, comprising 56 metacarpal shaft fractures, were retrospectively identified. Patients treated with a percutaneous approach demonstrated significantly improved TAM (248° ± 10° vs 228° ± 19°, P < .05), grip strength (95 ± 4 % vs 75% ± 6%, P < .05), and QuickDASH scores (2.5 ± 2.6 vs 10.5 ± 4.0, P < .05) through 2 weeks after surgery, with differences dissipating by 4 weeks, and no cases of extensor lag seen. Additionally, the percutaneous approach yielded significantly shorter intraoperative times (9.5 minutes vs 18.6 minutes, P < .05).
CONCLUSIONS: A percutaneous approach for rIMF of metacarpal shaft fractures significantly improved outcomes including TAM, grip strength, and QuickDASH scores through the 2-week postoperative period and demonstrated lower initial visual analog scale pain scores. Additionally, the percutaneous cohort experienced no cases of extensor lag at any time point.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
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