Retrograde Intramedullary Absorbable Pin Fixation for Intraarticular Fracture of the Metacarpal Head

• Main Authors: Atsushi Okazaki, MD, PhD, Hiroaki Sakano, MD, PhD, Yutaka Inaba, MD, PhD
• Format: Article
• Language: English
• Published: Elsevier 2019-10-01
• Series: Journal of Hand Surgery Global Online
• Online Access: http://www.sciencedirect.com/science/article/pii/S2589514119300647

Purpose: To review retrospectively the outcome of retrograde intramedullary absorbable pin fixation for intra-articular fractures of the metacarpal head. Methods: Nine patients with intra-articular fractures of the metacarpal head were treated surgically with 1.5-mm-diameter unsintered hydroxyapatite particles and a poly-l-lactide pin. There were 2 women and 7 men, mean age 28.9 years. Patients were observed for a mean of 13.1 months after surgery. The metacarpophalangeal joint was exposed through a dorsal skin incision. After reduction of the fracture, 2 unsintered hydroxyapatite particles and poly-l-lactide pins were inserted from the articular surface of the distal bone fragment into the medullary canal of the metacarpal. A volar aluminum orthosis was applied in the intrinsic plus position for a mean of 1.8 weeks (range, 0–4 weeks), and range of motion exercises were started after the orthosis was removed. Results: Anatomical reduction and bony union were achieved in all patients. Mean period required to achieve bone union was 4.6 weeks. No patients experienced pain after healing; all resumed normal activities at the time of follow-up, when mean flexion and extension of the metacarpophalangeal joint were 82.8° and –2.2°, respectively. There were no malunions or osteoarthritic changes, no breakage of the pin, aseptic inflammation, or avascular necrosis of the metacarpal head, and no foreign body reactions. Conclusions: We performed a retrograde intramedullary absorbable pin fixation for intra-articular fracture of the metacarpal head. Using this method, damage to the articular cartilage and surrounding soft tissue was minimized, range of motion exercise could be started early after surgery, and hardware removal surgery was not necessary. Type of study/level of evidence: Therapeutic IV. Key words: absorbable implant, metacarpal head fracture, poly-l-lactide pin, retrograde intramedullary fixation, unsintered hydroxyapatite particles