The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Blocking Screw Technique for Maintaining Reduction during Intramedullary Screw Fixation of Oblique Metacarpal Fractures

Document Type : TECHNICAL NOTE

Authors
Stephanie A. Kwan 1
William Wang 2
Amir R. Kachooei 3
Pedro K. Beredjiklian 3
Michael Rivlin 3
Jacob E. Tulipan 3
1 Department of Orthopaedic Surgery, Rowan University SOM, Stratford, NJ, USA
2 Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania, Rothman Institute, Philadelphia, PA, USA
3 Rothman Orthopaedic Insitute, AdventHealth, Orlando, FL, USA
10.22038/abjs.2022.63453.3062
Abstract
Intramedullary screw fixation provides a less-invasive means of surgically managing metacarpal fractures. While there
are advantages to using this technique compared to CRPP and ORIF, disadvantages of intramedullary screw fixation
include loss of reduction intraoperatively due to sagittal and coronal plane translation. The blocking screw technique
has been previously described as a solution for this problem in intramedullary fixation of long bone fractures. We
describe the blocking screw technique as applied to aid intramedullary screw fixation of metacarpals.
Level of evidence: V
Keywords
Blocking screw
Intramedullary screw
Fracture
Metacarpal
Treatment
Subjects
  1. Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am. 2013;38(5):1021-1031; quiz 1031. doi:10.1016/j.jhsa.2013.02.017
  2. Diaz-Garcia R, Waljee JF. Current Management of Metacarpal Fractures. Hand Clin. 2013;29(4):507-518. doi:10.1016/j.hcl.2013.09.004
  3. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal Fractures: Treatment and Complications. Hand (New York, N,Y). 2014;9(1):16-23. doi:10.1007/s11552-013-9562-1
  4. Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am. 1985;10(4):466-472. doi:10.1016/S0363-5023(85)80067-8
  5. Greeven APA, Bezstarosti S, Krijnen P, Schipper IB. Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review. Eur J Trauma Emerg Surg. 2016;42(2):169-175. doi:10.1007/s00068-015-0507-y
  6. Wong VW, Higgins JP. Evidence-Based Medicine: Management of Metacarpal Fractures. Plast Reconstr Surg. 2017;140(1):140e-151e. doi:10.1097/PRS.000 0000000003470
  7. Dreyfuss D, Allon R, Izacson N, Hutt D. A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures. Hand (New York, N,Y). 2019;14(1):27-33. doi:10.1177/1558944718798854
  8. Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am. 2014;39(12):2390-2395. doi:10.1016/j.jhsa. 2014. 08.016
  9. Urbanschitz L, Dreu M, Wagner J, Kaufmann R, Jeserschek JM, Borbas P. Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures. J Hand Surg Eur Vol. 2020;45(6):601-607. doi:10.1177/1753193420919060
  10. Jann D, Calcagni M, Giovanoli P, Giesen T. Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws. Hand Surg Rehabil. 2018;37(2):99-103. doi:10.1016/j.hansur.2017.12.005
  11. Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques. Arch Trauma Res. 2016;5(3):e32933. doi:10.5812/atr.32933
  12. Hoang D, Vu CL, Huang JI. Evaluation of Antegrade Intramedullary Compression Screw Fixation of Metacarpal Shaft Fractures in a Cadaver Model. J Hand Surg Am. 2021;46(5):428.e1-428.e7. doi:10.1016/j.jhsa.2020.10.026
  13. Orbay J. Intramedullary Nailing of Metacarpal Shaft Fractures. Tech Hand Up Extrem Surgy. 2005;9(2):69-73. doi:10.1097/01.bth.0000 167253.31976.95
  14. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br. 1999;81-B(6):963-968. doi:10.1302/0301-620X.81B6.0810963
  15. Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H. The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma. 1999;13(8):550-553. doi:10.1097/00005131-199911000-00006
  16. Hannah A, Aboelmagd T, Yip G, Hull P. A novel technique for accurate Poller (blocking) screw placement. Injury. 2014;45(6):1011-1014. doi:10.1016/j.injury.2014.02.029
  17. Ricci WM, OʼBoyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the Proximal Third of the Tibial Shaft Treated With Intramedullary Nails and Blocking Screws: J Orthop Trauma. 2008;22(Supplement 3):S39-S45. doi:10.1097/BOT.0b013e31816c02a5
  18. Auston D, Donohue D, Stoops K, et al. Long Segment Blocking Screws Increase the Stability of Retrograde Nail Fixation in Geriatric Supracondylar Femur Fractures: Eliminating the “Bell-Clapper Effect.” J Orthop Trauma. 2018;32(11):559-564. doi:10.1097/BOT.0000000000001284
  19. Schumaier AP, Southam BR, Avilucea FR, et al. Factors Predictive of Blocking Screw Placement in Retrograde Nailing of Distal Femur Fractures. J Orthop Trauma. 2019;33(6):e229-e233. doi:10.1097/BOT.0000000000001450
The Archives of Bone and Joint Surgery
Volume 10, Issue 12
December 2022
Pages 1056-1059

  • Receive Date 07 February 2022
  • Revise Date 10 October 2022
  • Accept Date 17 October 2022