Clinical considerations in intramedullary headless screw fixation of metacarpal and proximal phalanx fractures

Table 1 Indications, contraindications, and key selection criteria for intramedullary headless screw vs Kirschner wire vs plate fixation in metacarpal and proximal phalanx fractures

Criterion	IMHS	K-wire	Plating
Extra-articular transverse/oblique	Preferred	Acceptable	Acceptable
Metacarpal neck	Preferred	Acceptable	Less ideal
Comminuted diaphyseal	Acceptable	Poor control	Preferred
Intra-articular	Contraindicated	Limited role	Preferred
Osteoporotic bone	Caution	Acceptable	Preferred
Open fracture Gustilo I	Acceptable	Acceptable	Acceptable
Open fracture Gustilo II/III	Contraindicated	Caution	Preferred
Pediatric (open physes)	Contraindicated	Preferred	Rarely
Need for early motion	Best	Poor	Good
Resource-limited setting	Costly	Best	Moderate cost
Learning curve	Moderate	Low	Moderate-high

IMHS: Intramedullary headless screw; K-wire: Kirschner wire.