Saleh WR, Khalifa AA, Ragheb YF, El-Sayed A, Megahed AA. Intramedullary headless screw fixation of extraarticular metacarpal and proximal phalanx fractures, North African trauma center early experience. World J Orthop 2026; 17(4): 115014 [DOI: 10.5312/wjo.v17.i4.115014]
Corresponding Author of This Article
Ahmed A Khalifa, MD, Assistant Professor, FRCS, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena 83523, Qina, Egypt. ahmed_adel0391@med.svu.edu.eg
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Orthopedics
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Observational Study
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Apr 18, 2026 (publication date) through Apr 17, 2026
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World Journal of Orthopedics
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Saleh WR, Khalifa AA, Ragheb YF, El-Sayed A, Megahed AA. Intramedullary headless screw fixation of extraarticular metacarpal and proximal phalanx fractures, North African trauma center early experience. World J Orthop 2026; 17(4): 115014 [DOI: 10.5312/wjo.v17.i4.115014]
World J Orthop. Apr 18, 2026; 17(4): 115014 Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.115014
Intramedullary headless screw fixation of extraarticular metacarpal and proximal phalanx fractures, North African trauma center early experience
Waleed R Saleh, Ahmed A Khalifa, Yaser F Ragheb, Amr El-Sayed, Ahmed A Megahed
Waleed R Saleh, Yaser F Ragheb, Amr El-Sayed, Ahmed A Megahed, Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut 71515, Egypt
Ahmed A Khalifa, Department of Orthopedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
Ahmed A Khalifa, Department of Orthopedic, Aster Sanad Hospital, Riyadh 14236, Saudi Arabia
Co-first authors: Waleed R Saleh and Ahmed A Khalifa.
Author contributions: Saleh WR and Khalifa AA did the critical revision and they contributed equally to this manuscript as co-first authors; Saleh WR and Megahed AA carried out the study conception; Khalifa AA, Ragheb YF, and Megahed AA carried out the literature review and prepared the manuscript draft; Khalifa AA and El-Sayed A prepared the figures and tables; Megahed AA and El-Sayed A performed patient assessment, data collection, and analysis; all authors discussed and commented on the final manuscript. All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the ethical committee of Assiut Faculty of Medicine (approval No. 04-2024-200749, Assiut University, Egypt).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All the data are included within the manuscript. The original data could be shared upon a justifiable written request addressed to the corresponding authors at ahmed_adel0391@med.svu.edu.eg.
Corresponding author: Ahmed A Khalifa, MD, Assistant Professor, FRCS, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena 83523, Qina, Egypt. ahmed_adel0391@med.svu.edu.eg
Received: October 11, 2025 Revised: November 24, 2025 Accepted: January 28, 2026 Published online: April 18, 2026 Processing time: 187 Days and 13.7 Hours
Abstract
BACKGROUND
Intramedullary headless screw (IMHS) fixation for metacarpal and phalanx fractures has shown comparable, and sometimes superior, outcomes compared with other management techniques; however, this option is not standard in our area.
AIM
To evaluate our early experience of using IMHS fixation for managing extraarticular metacarpal and proximal phalanx fractures by reporting the functional, radiographic, and complication outcomes from a North African level one trauma center.
METHODS
In the current prospective single surgeon case series, 53 patients having a mean age of 33.79 ± 12.69 years presented with 67 extraarticular fractures (51 metacarpals and 16 proximal phalanx) over one year were treated by retrograde and antegrade IMHS fixation for metacarpal and proximal phalanx fractures, respectively. The total active range of motion, Quick Disabilities of the Arm, Shoulder, and Hand score, and hand grip strength were among the functional outcomes, besides reporting the fracture union as a radiographic outcome and the complication rate.
RESULTS
wide awake local anaesthesia was utilized in 70.2% of the cases; the mean operative time was 14.37 ± 3.46 minutes, and closed fracture reduction was achieved in 95.5% of the fractures. Fracture union was achieved in all patients after a mean of 5.62 ± 0.99 weeks. At a mean last follow-up of 101.19 ± 52.31 days, the mean total active range of motion was 253.15° ± 10.29°. The mean percentage of grip strength was 98.66% ± 1.31% of the contralateral hand, and the mean Quick Disabilities of the Arm, Shoulder, and Hand score was 15.08 ± 11.95. The overall complication rate was 7.51%; all were considered minor, including shortening with or without metal protrusion (2.99%) and malunion (1.49%). There were no cases of nonunion, infection, or refracture, and there were no secondary surgeries.
CONCLUSION
We achieved promising early functional and radiological results after adopting IMHS fixation for extraarticular metacarpal and proximal phalanx fractures, with a relatively lower complication rate. These results have led to changes in our institution’s practice for managing hand fractures.
Core Tip: Although intramedullary headless screw fixation is a well-documented management option for metacarpal and phalanx fractures, its broad adoption in our area is limited. We conducted this prospective study to evaluate the efficiency and outcomes of intramedullary headless screw fixation for metacarpal and proximal phalanx fractures, using either retrograde or antegrade fixation techniques. The clinical, radiological, and complication outcomes we observed after managing 67 extraarticular fractures in 53 patients were promising and comparable to those reported in the literature, which helped change our institutional management protocol for such fractures.
