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

Table 3 Comparative outcomes of intramedullary headless screw vs Kirschner wire vs plate fixation for metacarpal fractures (based on meta-analyses)

Outcome measure	IMHS	K-wire	Plating	Evidence level
DASH score (mean)	0.6	7.4	9.8	Meta-analysis[7,14]
Grip strength recovery	Superior	Moderate	Comparable to IMHS	Meta-analysis[7,24]
Reoperation rate	4%	11%	11%	Meta-analysis[7]
Infection rate	< 3%	5%-15% (pin tract)	< 3%	Systematic review[14]
Union rate	> 97%	95%-98%	> 97%	Systematic review[14]
Operative time	Short	Shortest	Longest	Cohort studies[19,21]
Early mobilization	Yes (no splint)	No (splint required)	Yes	Cohort studies[43,45]
Implant removal	Rarely required	Usually required	Sometimes required	Systematic review[38,39]
Implant cost	Moderate-high	Low	Moderate-high	Cost analysis[20]

DASH: Disabilities of the arm, shoulder and hand; IMHS: Intramedullary headless screw; K-wire: Kirschner wire.