Supplemental Use Guide – Intramedullary Fixation of Metacarpal Fractures: Antegrade Approach

Metacarpal fractures account for up to 10% of all fractures. Traditionally, displaced transverse fractures are fixated with plate and screw constructs.
Antegrade Approach Overview: The approach is ideal for transverse or short oblique fractures in the proximal metacarpal shaft with the aim of avoiding injury of the articular cartilage of the metacarpal head and the extensor mechanism. Traditionally, the retrograde approach for intramedullary screw fixation of a metacarpal fracture entails performing an arthrotomy through the dorsal joint capsule and either splitting the extensor tendon or incising the adjacent sagittal band. The fracture is reduced by introducing a guide wire retrograde, starting at the metacarpal head, down the shaft, and across the fracture site to the base of the metacarpal. The metacarpal head and canal are drilled, followed by screw placement. Antegrade screw fixation is performed through the articular surface at the base of the metacarpal, down the shaft, and across the fracture site. This technique avoids injury to the extensor mechanism and the articular surface of the metacarpal head. This guide is intended for supplemental use only and is not intended to be used as a stand-alone surgical technique. Reference the Acumed Acutrak 2 Headless Compression Screw System Surgical Technique (SPF00-02) for more information.