Rahmati Kasra, Jain Nirbhay S, Bollavaram Keval, Gamalong Giovanni M, Benhaim Prosper, Azari Kodi K
University of California, Los Angeles, USA.
Hand (N Y). 2025 Jan 27:15589447241312416. doi: 10.1177/15589447241312416.
Multiple approaches exist for operative fixation of metacarpal fractures; with common treatments including lag screw fixation or open-reduction internal fixation (ORIF) with plates and screws. Recently, the adaptation of intramedullary screw (IMS) placement has allowed for an essentially closed approach with stable fixation and theoretically improved outcomes. Thus, we sought to compare such approaches to ultimately determine the superior method for achieving the goal of return to normal function.
We performed a retrospective study of all patients in our institution with metacarpal fractures requiring operative fixation over a 10-year period, with at least 6 months follow-up. Preoperative demographics, fracture characteristics, and operative data were collected. First digit metacarpal fractures along with any occurring at the base of the bone were excluded, as IMS fixation is not typically performed in such cases. Postoperative outcomes, including range of motion, hand therapy requirements, and time to subjective recovery were also compared.
A total of 154 metacarpals were included in this study. Patients treated via IMS experienced shorter operative and tourniquet times compared to ORIF, with a faster return to subjective normal function, a greater range of motion, and reduced need for hand therapy. Complication rates were similar. This held true in isolated metacarpal fractures as well.
Intramedullary screw exhibited improved functional outcomes when compared against ORIF, exhibiting improved patient outcomes with comparable complication rates and should be considered as a method for fixation of metacarpal fractures within appropriate settings.
掌骨骨折的手术固定有多种方法；常见的治疗方法包括拉力螺钉固定或钢板螺钉切开复位内固定（ORIF）。最近，髓内螺钉（IMS）置入技术的应用实现了一种基本闭合的手术方式，固定稳定，理论上能改善治疗效果。因此，我们试图比较这些方法，以最终确定实现恢复正常功能这一目标的最佳方法。
我们对本机构10年间所有需要手术固定的掌骨骨折患者进行了一项回顾性研究，随访时间至少6个月。收集术前人口统计学资料、骨折特征和手术数据。第一掌骨骨折以及任何发生在掌骨基底的骨折均被排除，因为在这些情况下通常不进行IMS固定。还比较了术后结果，包括活动范围、手部治疗需求和主观恢复时间。
本研究共纳入154例掌骨骨折患者。与ORIF相比，接受IMS治疗的患者手术时间和止血带使用时间更短，主观恢复到正常功能的速度更快，活动范围更大，手部治疗需求减少。并发症发生率相似。孤立性掌骨骨折的情况也是如此。
与ORIF相比，髓内螺钉在功能结果方面表现更佳，在并发症发生率相当的情况下患者预后更好，在合适的情况下应考虑将其作为掌骨骨折的固定方法。
