Surgical techniques for intramedullary headless screw fixation of metacarpal and proximal phalanx fractures

Fractures of the metacarpals and phalanges are among the most common upper extremity injuries. They can be managed non-operatively or operatively; the latter offers a wide range of options, including plate fixation, Kirschner wires, and intramedullary headless screws (IMHS), which rely on the surgeon’s preference and the fracture characteristics. Most of the previously mentioned fixation methods showed acceptable outcomes; however, IMHS fixation emerged as a promising technique, with some reports showing superior functional, radiological, and complication outcomes compared to other management options. For managing metacarpal fractures, IMHS can be inserted in a retrograde fashion, while for phalanx fractures, they might be inserted in an antegrade or retrograde fashion. Here, we described the various possible techniques for IMHS fixation of metacarpal and proximal phalanx extra-articular fractures. Furthermore, we mentioned some of the precautions, advantages, and disadvantages of this fixation method.