Khalifa AA, Megahed AA, Imran A. Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review. World J Clin Pediatr 2026; 15(4): 120900 [DOI: 10.5409/wjcp.120900]
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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Khalifa AA, Megahed AA, Imran A. Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review. World J Clin Pediatr 2026; 15(4): 120900 [DOI: 10.5409/wjcp.120900]
World J Clin Pediatr. Dec 9, 2026; 15(4): 120900 Published online Dec 9, 2026. doi: 10.5409/wjcp.120900
Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review
Ahmed A Khalifa, Ahmed A Megahed, Ahmad Imran
Ahmed A Khalifa, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
Ahmed A Khalifa, Ahmad Imran, Department of Orthopedic, Aster Sanad Hospital, Riyadh 13216, Riyadh, Saudi Arabia
Ahmed A Megahed, Department of Orthopaedic and Traumatology, Assiut University Hospital, Assiut 71515, Egypt
Author contributions: Khalifa AA conceptualized the study, performed data analysis, and critically revised the manuscript; Megahed AA and Imran A collected and extracted data; Khalifa AA, Megahed AA, and Imran A conducted the literature review, prepared the initial manuscript draft, and designed the tables; all authors discussed, commented on, read and approved the final manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: March 11, 2026 Revised: April 5, 2026 Accepted: June 1, 2026 Published online: December 9, 2026 Processing time: 191 Days and 22.1 Hours
Abstract
BACKGROUND
Intramedullary headless screws (IMHS) have become increasingly popular for metacarpal and phalangeal fracture fixation in adults. However, evidence regarding their use in pediatric patients remains limited. Biological concerns include physeal injury, implant migration, and long-term growth disturbances.
AIM
To evaluate the safety and clinical outcomes of IMHS fixation for pediatric hand fractures.
METHODS
A systematic review was conducted using predefined inclusion criteria to identify clinical studies reporting IMHS fixation in patients aged < 16 years with metacarpal or phalangeal fractures. Three articles met the criteria, comprising two case reports and one case series. Extracted data included patient age, fracture location, fixation approach, follow-up duration, radiographic union, complications, and functional outcomes.
RESULTS
Thirteen pediatric patients (14 fractures) were analyzed, with a mean age of 9.5 years (range 5-12). Fracture patterns were predominantly proximal phalangeal (n = 12, 85.7%), with two metacarpal shaft fractures. IMHS fixation was performed via retrograde (n = 9) or antegrade (n = 4) approaches. The mean follow-up across studies was 26.1 months (range 6-36). Radiographic union was achieved in all fractures, with no implant migration, screw breakage, infection, or physeal disturbance reported. Functional outcomes were excellent in nearly all cases, with full restoration of range of motion in 12 patients and mild, non-limiting motion restriction in one patient. The overall complication rate was 0% among all patients.
CONCLUSION
Although limited to small case reports and a single series, current evidence suggests that IMHS fixation may be a safe and effective option for selected pediatric metacarpal and phalangeal fractures. Larger prospective comparative studies are necessary to assess further long-term outcomes, physeal safety, and optimal indications.
Core Tip: Pediatric hand fractures are primarily treated with conservative approaches using immobilization, with acceptable outcomes. A subset of these fractures is amenable to operative management, especially those with malalignment or displacement, or when conservative management fails. Closed reduction and fixation using intramedullary headless screws (IMHS) is an operative management option that has proven efficacy in adults. Although the current systematic review included a small number of patients, IMHS fixation of pediatric metacarpal or proximal phalanx fractures resulted in excellent functional outcomes, 100% union rate, and 0% complications. These early results are encouraging and suggest that IMHS should be considered for operative management of pediatric hand fractures.
