Thomas Jefferson University, Philadelphia, PA, USA.
Hand Surgery PC, Newton, MA, USA.
Hand (N Y). 2020 Nov;15(6):798-804. doi: 10.1177/1558944719836214. Epub 2019 Mar 20.
There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.
最近，无头加压螺钉在掌骨颈和骨干骨折固定中的应用越来越多，因为它们具有许多优势，且报告的并发症很少。本研究旨在评估逆行髓内无头加压螺钉固定掌骨骨折后的临床并发症及其解决方案。我们通过对 3 名手部 fellowship培训医生治疗的所有采用髓内无头螺钉固定掌骨骨折的患者进行回顾性多中心病例系列研究，来描述并发症及其处理方法。我们对每个病例的患者人口统计学资料、使用的植入物、并发症类型、术前和术后 X 线片、手术报告和后遗症进行了回顾。我们将并发症定义为感染、固定丢失、器械失败、旋转移位、骨不连、畸形愈合、金属过敏和任何重复手术干预。通过对 160 例掌骨骨折的回顾性研究，发现了 4 例并发症（2.5%）。1 例为镍过敏，1 例为重复外伤后螺钉断裂，2 例患者的髓内螺钉弯曲。3 例患者的螺钉取出简单，无并发症或持续受限。1 例带有再骨折的弯曲螺钉仍保留在原位。未出现严重并发症。髓内螺钉固定掌骨骨折是安全的，并发症发生率低（2.5%），可以安全有效地处理。
