Intramedullary Fixation for Metacarpal Fractures: A Multi-Institutional Prospective Outcomes Study.

Purpose: Intramedullary fixation (IMF) has emerged as an effective treatment for metacarpal fractures. Benefits include stable fixation that allows early postoperative rehabilitation and high fracture union rates, without increased complications. Both headless compression screws and intramedullary threaded noncompressive nails have been described for this purpose; however, prospective outcomes reporting are lacking. This study assessed the outcomes of metacarpal fractures treated with IMF including patient-reported outcomes, grip strength, total active motion, and complications. Methods: A prospective multicenter trial enrolled consecutive patients with closed, extra-articular metacarpal fractures treated with IMF. Radiographic healing was assessed at each postoperative visit and patient-reported outcomes included pain scores, Results: One-hundred-one fractures were treated in 82 patients with an average age of 33 years and mean follow-up of 69 days. Most patients were male (70%), nonlaborers (72%), and nonsmokers (74%). Conclusions: Intramedullary fixation is a reliable technique for treatment of extra-articular metacarpal fractures with satisfactory patient-reported outcomes, excellent strength and motion, and a low complication rate. Intramedullary fixation should be considered for closed, extra-articular metacarpal fractures. Type of study/level of evidence: Therapeutic IV.