Figure 10. Fluoroscopic Assessment of Metacarpal Neck Fracture Treated by Reduction and Intramedullary Fixation With a Headless Compression Screw.

A and B, Intramedullary fixation with a headless compression screw is best indicated for neck and not shaft fractures, the technique requires exposure of the metacarpal head through a split in the extensor mechanism; C, D and E, the fracture is reduced and the guidewire is directed retrograde through the metacarpal head. Since the fracture typically flexes, the guidewire should be placed slightly volar in the metacarpal head as it is directed into the shaft, thereby aiding in reduction of the fracture by extending the fracture as the screw is inserted; F, the headless compression screw is then passed over the guidewire. The length of the screw should be measured so that it ends in the isthmus of the fracture and not the base in order to obtain good fixation while avoiding over-correction of the normal bow of the metacarpal; G, H and I, adequate reduction is held by one of these headless compression screws.