Intramedullary cannulated screw fixation for hand fractures: patient-reported,clinical and radiological outcomes at 5 year follow-up

Abstract

Introduction:

Intrameduallry cannulated screw fixation is a relative recent technique that can be used for metacarpal and phalangeal fractures. The aim of the study was to report patient-reported, clinical and radiological outcomes at a median follow-up of 5 years.

Methods:

Sixty-seven patients with 38 metacarpal and 31 phalangeal fractures were treated with cannulated screws. Median follow-up was 5 years (interquartile range, IQR 3.5 to 6.5), and the median age of the patients at the time of surgery was 45 years. Outcomes were assessed with the Michigan Hand Questionnaire (MHQ) and the Patient-Specific Functional Scale (PSFS). Clinical outcomes were range of motion and grip strength, and radiological outcomes included fracture healing and joint degeneration. Revisions and complications were also recorded. All patients filled in the questionnaires and 47 of those attended clinical and radiological follow-up.

Results:

Median MHQ score was 90 (IQR 75–100) and median PSFS score was 9 (IQR 5 to 10), indicating high satisfaction and favourable function. Median total active motion was 283° (IQR 254 to 311°) and median grip strength was 40 kg (IQR 35 to 45 kg). Radiographs showed that all fractures had healed in a good position. Radiographic degenerative changes were observed in five patients, and nine patients underwent revision procedures due to soft-tissue adhesions (n = 3), hardware-related complications, including screw malposition, migration or bending (n = 3), and reduction problems, such as secondary displacement or rotational malalignment (n = 3).

Conclusion:

Cannulated screw fixation provided good medium-term functional outcomes and high patient satisfaction in metacarpal and phalangeal fractures. A 13.4% revision rate was observed, which is lower compared with historical data on fracture fixation with plates.

Level of evidence: III