Comparison of antegrade and retrograde headless cannulated screw fixation in patients with metacarpal fracture: A prospective randomized comparative study

Purpose: In our study, we aimed to compare the results of fixation of metacarpal fractures with headless cannulated screws towards distal or proximal on pain, function and quality of life in patients with metacarpal fractures. Method: Patients admitted to Pamukkale University Orthopedics and Traumatology Department, due to metacarpal fracture were prospectively included in the study and randomly grouped. A total of 22 patients and 26 metacarpal fractures were assessed. Group 1 patients were operated with proximal entry (antegrade), and group 2 with distal entry (retrograde), using intramedullary headless cannulated screws. Appropriate screw selection was made by measuring the metacarpal isthmus diameter of the patient's x-ray results (AP and oblique direction). We used headless cannulated screws with diameters between 3.5mm and 5 mm in the patients. In the study, the age, gender, fracture site, cause of fracture, educational status of the patients were recorded as demographic data. After the surgery, at sixth week union of the fracture were assesed radiographically and functional status and pain of the patient were documented. Results: In our study, 81.8% of all patients were male. The average age was 36.75 in group I and 28.50 in group II. High school and associate/undergraduate graduates (40.9%) were equal in both groups. 5 Patients in both groups reported cigarette use. The dominant hand was the right side in 95.5% of the patients included in the study. It showed a similar distribution between the right/left extremities in the affected hand. The affected metacarpal bone was 5. Metacarpal bone in the majority of both groups. There were no statistically significant difference between the clinical data of the patients and the groups (p>0.050). We obtained similar results between groups in pain scores (p>0.050). In group I, VAS scores in activity (p=0.017) and in group II, VAS scores in exercise (p=0.042) decreased statistically significantly with time. The difference between groups in TAH scores was in favor of group II only at Week 6 (p=0.003). TAH was categorized as good level in all patients in group I. TAH was categorized as fair in 2 patients and very good in 3 patients in group II. There were statistically significance between groups with TAH categorization (p=0.021). In group I, we received a statistically significantly lower score in all parameters in the operated hand compared to the healthy side (p<0.050). In group II, we obtained a similar measurement score between the intact extremity and the hands with which we fixed the fracture in grasping (p = 0.878). In other parameters, healthy extremities scored significantly better. There were no significant difference between the groups in the Michigan Hand Outcome Survey (p>0.050). All fractures showed union by the time of the 6th week control X-rays. When the time to the beginning of physical theraphy after surgery was recorded, group II exhibited better outcomes compared to group I, with an average of 8.5 days compared to 12.33 days. However, there was no statistically significant difference between the two groups (p = 0.180). Conclusions: As a result of our study, we think that both methods may be used safely without considering the location of the fracture.