Skeletally mature patients with metacarpal shaft or neck fractures requiring surgical intervention
Care Setting
Surgical treatment with early mobilisation protocol without postoperative immobilisation
Key Highlights
Intramedullary headless compression screw fixation allows stable fixation with minimal soft tissue disruption and low complication rates.
Early active mobilisation without postoperative splinting is feasible and safe following stable intramedullary fixation.
Surgical technique involves retrograde insertion of a headless screw under fluoroscopic guidance with intraoperative stability confirmation.
Guideline-Based Recommendations
Diagnosis
Identify metacarpal shaft or neck fractures with significant angulation, rotational deformity, instability, or functional impairment requiring surgery.
Exclude intra-articular fracture extension, pathological fractures, and concomitant tendon or neurovascular injuries.
Management
Perform intramedullary headless compression screw fixation using a standardised retrograde technique under fluoroscopic guidance.
Select the largest screw diameter safely accommodated by the medullary canal to achieve three-point fixation.
Confirm intraoperative stability by applying axial, bending, and rotational stress under fluoroscopy.
Avoid postoperative immobilisation; initiate immediate active range-of-motion exercises and allow light activities as tolerated.
Monitoring & Follow-up
Conduct clinical and radiological follow-up for a minimum of three months to assess union, functional recovery, and complications.
Evaluate functional outcomes using clinical examination and QuickDASH questionnaire.
Assess rotational alignment clinically by inspecting digital cascade and fist closure.
Risks
Potential complications include implant migration, tendon irritation, and infection, though rates are low with this technique.
Avoid cortical breach during screw insertion to prevent iatrogenic injury.
Patient & Prescribing Data
Skeletally mature patients with metacarpal shaft or neck fractures treated surgically
Intramedullary headless compression screw fixation enables early mobilisation without splinting, leading to satisfactory union rates and functional outcomes.
Clinical Best Practices
Use fluoroscopic guidance to ensure central intramedullary screw trajectory and correct screw positioning.
Perform closed reduction prior to screw insertion to restore anatomical alignment.
Confirm screw stability intraoperatively before wound closure to allow immediate mobilisation.
Educate patients on early active mobilisation and gradual return to activities of daily living postoperatively.
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
