Retrograde Intramedullary Pinning of Metacarpal Fractures Through the Collateral Recess

There are several common types of fixations for metacarpal fractures: pins, plates, lag, and intramedullary (IM) screws. The advantages of pins are that they are ubiquitous, cost-effective, have shorter operative times, and preserve soft tissues, thereby minimizing adhesions. In this article, we describe metacarpal fracture fixation utilizing the technique of retrograde IM pinning through collateral recess access. We present the postoperative outcomes of our patients who underwent metacarpal fracture fixation utilizing this technique. Details of the fractures, patient comorbidities, demographics, and postoperative outcomes were gathered. Primary outcomes investigated were nonunion, malunion, need for revision, and range of motion (ROM). A total of 29 fractures in 14 patients were included, with multiple fractures present in 8 patients. The fractures were open in 8 cases. The orientation of the fracture was transverse in 22 cases and oblique in 7 with comminution noted in 13 fractures. Full ROM was obtained in 15 digits with 6 digits noted to have a good ROM and 6 digits still undergoing therapy. There were no nonunions noted and only one malunion. In conclusion, retrograde, double IM pinning through collateral recess access represents a reliable, cost-effective, and minimally traumatic method of metacarpal fixation, including carpometacarpal fracture dislocations.