Metacarpal fractures are common upper extremity fractures. Surgical fixation is recommended for open injuries, segmental ...
read more ↘ bone loss, multiple metacarpal fractures, irreducible fractures, and unstable fracture patterns. For transverse and short oblique metacarpal shaft fracture patterns, a number of surgical fixation options exist including the use of intramedullary Kirschner wires, plates and screws, and most recently intramedullary headless compression screws (IMHCS). IMHCS fixation has been unanimously performed in a retrograde manner in which a guidewire and then a cannulated headless screw is placed through a skin excision, a split in the sagittal band or extensor tendon, and the dorsal central articular cartilage surface of metacarpal head. In this article, we detail a step-by-step novel approach to fixation of transverse and short oblique metacarpal fractures through an antegrade approach using IMHCS. We have found that placement of the screw through an antegrade trajectory through the base of the metacarpals is effective for proximal and midshaft metacarpal fractures involving any of the five hand metacarpals. Violation of the articulating surface of the trapezoid, capitate, and hamate can be avoided at the carpometacarpal articulation as well. Furthermore, this approach avoids creation of defects in the extensor tendon, sagittal band, and the cartilaginous articular surface of the metacarpal head at the metacarpophalangeal joint as well as the need for excessive countersinking within the metacarpal shaft through a retrograde approach. We have included a detailed 4K HD video demonstration of our surgical technique.
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