Emara KM, Diab RA, Hussein M, Abuelwafa M, Eissa MO. Clinical considerations in intramedullary headless screw fixation of metacarpal and proximal phalanx fractures. World J Orthop 2026; 17(7): 120372 [DOI: 10.5312/wjo.120372]
Corresponding Author of This Article
Mohamed Osama Eissa, Lecturer, Department of Orthopedic Surgery, Ain Shams University, No. 38 Abbassia Street, Cairo 11591, Egypt. mohamed.eissa@med.asu.edu.eg
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Orthopedics
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review-article
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Emara KM, Diab RA, Hussein M, Abuelwafa M, Eissa MO. Clinical considerations in intramedullary headless screw fixation of metacarpal and proximal phalanx fractures. World J Orthop 2026; 17(7): 120372 [DOI: 10.5312/wjo.120372]
World J Orthop. Jul 18, 2026; 17(7): 120372 Published online Jul 18, 2026. doi: 10.5312/wjo.120372
Clinical considerations in intramedullary headless screw fixation of metacarpal and proximal phalanx fractures
Khaled M Emara, Ramy Ahmed Diab, Mohamed Hussein, Mahmoud Abuelwafa, Mohamed Osama Eissa
Khaled M Emara, Ramy Ahmed Diab, Mohamed Hussein, Mohamed Osama Eissa, Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
Mahmoud Abuelwafa, Department of Orthopedic Surgery, Al-Azhar University, Cairo 11511, Egypt
Author contributions: Emara KM and Diab RA carried out the study conception; Eissa MO, Hussein M, and Abuelwafa M carried out the literature review and prepared the manuscript draft; Eissa MO prepared the figures and tables; Abuelwafa M, and Hussein M performed data collection, and analysis; all authors discussed and commented on the final manuscript. All authors read and approved the final manuscript.
AI contribution statement: AI-assisted language tool (Grammarly) was used solely for grammar checking and language refinement. The entirety of the main text was written by the authors. No portion of the manuscript text was AI-generated. An AI-assisted grammar and language polishing tool (Grammarly) was used to improve readability and correct grammatical errors. All intellectual content remains solely the work of the authors. No AI tool participated in the design of the study or the interpretation of its results. No images in the manuscript were generated by AI.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.
Corresponding author: Mohamed Osama Eissa, Lecturer, Department of Orthopedic Surgery, Ain Shams University, No. 38 Abbassia Street, Cairo 11591, Egypt. mohamed.eissa@med.asu.edu.eg
Received: February 25, 2026 Revised: April 16, 2026 Accepted: May 22, 2026 Published online: July 18, 2026 Processing time: 136 Days and 11.4 Hours
Abstract
Intramedullary headless screw (IMHS) fixation has gained increasing acceptance as a minimally invasive option for extra-articular metacarpal and proximal phalanx fractures. Recent prospective studies and systematic reviews demonstrate high union rates, favorable functional outcomes, and low complication incidence, particularly in diaphyseal and neck fractures of skeletally mature patients. The technique offers key advantages: Stable intramedullary fixation, preserved soft-tissue integrity, short operative times, and early mobilization without routine splinting. However, successful application depends on careful patient selection, precise guidewire placement to avoid rotational malalignment, appropriate implant choice, and meticulous protection of articular cartilage and extensor tendons. Comparative analyses indicate that IMHS achieves equivalent or superior functional recovery and significantly lower reoperation rates compared with Kirschner wire (K-wire) and plate-and-screw fixation in selected fracture patterns, though concerns persist regarding articular cartilage violation, extensor tendon irritation, and the technical learning curve. Cost and implant availability remain barriers in resource-limited settings. This Opinion Review synthesizes current evidence on biomechanical principles, indications, surgical techniques, rehabilitation protocols, and the complication profile of IMHS fixation. Comparative outcomes against K-wires and plating are discussed, along with economic considerations. Drawing on the available literature and our clinical experience, we present our perspectives on optimal patient selection, technical refinements, and priority areas for future research.
Core Tip: Intramedullary headless screw fixation represents a minimally invasive and mechanically reliable option for selected extra-articular metacarpal and proximal phalanx fractures, enabling early unrestricted mobilization with low complication rates. Evidence from recent meta-analyses confirms lower reoperation rates and superior Disabilities of the arm, shoulder and hand scores compared with Kirschner wires and plating. Success depends on meticulous patient selection, central guidewire technique, and structured rehabilitation. Long-term multicenter studies are needed to confirm durability and fully define indications.
