Clinical Outcomes of Using Retrograde Intramedullary Headless Screw for Fixation of Metacarpal Fractures

Background: Metacarpal fractures are among the most common hand injuries. Surgical fixation options vary, but complications such as stiffness and hardware-related problems remain a challenge. Retrograde intramedullary headless screw (IMHS) fixation has emerged as a minimally invasive option that enables early mobilization.
Aim: This study aims to evaluate the outcomes of metacarpal fractures treated with retrograde IMHS fixation.
Subjects and Methods: We conducted prospective research on 20 cases (31 metacarpal fractures) treated with retrograde IMHS fixation. Data included demographics, fracture characteristics, operative details, complications, total active motion (TAM), grip strength, union time, Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analogue scale (VAS) for pain, and return-to-work time.
Results: All fractures united within a mean of 6.6 weeks. Patients achieved an average TAM of 94% and grip strength of 93% compared to the contralateral side. Mean DASH and VAS scores were low and return to work averaged 4.3 weeks. Complications were minor and transient. Subgroup analysis showed no significant differences except delayed return to work in multiple fractures and higher DASH scores in spiral fractures.
Conclusion: Retrograde IMHS fixation provides excellent stability, early mobilization, rapid union, and high patient satisfaction with low complication rates. It represents a reliable alternative to traditional fixation methods for managing metacarpal fractures.