Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases.

Abstract Objective The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type). Methods Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018. Results The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5th, 3rd, and 2nd (n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30o for the 2nd and 3rd metacarpals and > 40o for the 5th metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240o and returned to their former occupations. All fractures consolidated and there were no reinterventions. Discussion The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost. Conclusion This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.