Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review

Table 1 Basic study, patients, fracture, and management characteristics of the included patients

Ref.	Country of origin	Study type	Patient number (fracture number)	Age (years)	Gender	Side	Dominant side	Fracture location	Fracture location and description	Injury to surgery time	Indication for surgery	Treatment details	Size of screws	Postoperative protocol
d’Oliveira and Craviotto[22], 2023	Uruguay	Case report	1 (2)	8	M	Right side	No	Metacarpal of the middle and ring finger	Shaft spiral fractures	NR	Spiral configuration, rotational malalignment with scissoring	Closed reduction and fixation using antegrade IMHS	30-mm length headless screw for the 4th metacarpal, and a 32-mm screw for the 3rd metacarpal. Both screws were 2.4 mm in diameter	Splint for 1 week, followed by early mobilization
Ayık et al[23], 2025	Turkey	Case series	11 (11)	9.4 (5-15)	8 M and 3 F	8 right and 3 left	8 hands	Proximal phalanx: 5 index fingers; 3 middle fingers; 2 ring fingers; and 1 little finger	4 at the neck level, 4 at the shaft, and 3 at the base	2.5 days (0-9)	Unstable fractures (rotation, shortening, or displacement), fractures involving the neck, shaft, or closed physeal base; loss of reduction after conservative treatment	Closed reduction and 7 had retrograde IMHS fixation, 4 had antegrade IMHS fixation	NR	Same day discharge- Immobilization for 3-5 days. At the 5th postoperative day, home exercises and early ROM were started under supervision by a physiotherapist
Maes et al[21], 2025	Belgium	Case report	1 (1)	12	M	Right	NR	Proximal phalanx of the ring finger	Mid-diaphyseal	4 weeks (initially treated conservatively)	Malunion with volar angulation of 50 degrees (impeding finger ROM)	Closed reduction and retrograde IMHS fixation	A cannulated compression headless screw of 2 mm diameter	A protective orthosis and buddy loop were applied, and physical therapy was initiated early

M: Male; F: Female; NR: Not reported; ROM: Range of motion; IMHS: Intramedullary headless screw.

Table 2 Detailed outcomes (functional, radiological, and complications) of the included patients

Ref.	Follow up period (months)	Functional outcome	Radiological outcome	Complications	Hardware removal
d’Oliveira and Craviotto[22], 2023	6	No pain - no limitation of daily activities - DASH score was zero	Adequate bony union was achieved, and no displacement or rotational malalignment	None	NR
Ayık et al[23], 2025	29.1 (24-36)	10 patients had normal finger function; 1 patient had mild restriction	Fracture union was achieved within the first month in 9 patients, and within 2 months in 2 patients. No signs of joint degeneration	None	No routine removal was recommended. One patient had a retrograde screw removal at the parents’ request
		ROM compared with the contralateral side showed the following deficits: MCP joint: 1.8 (range 0-10), PIP joint: 2.7 (range: 0-10), and DIP joint: 0.9 (range: 0-10)
		Pain VAS score of 0.09 (range: 0-1)
		Functional VAS score of 9.7 (range: 8-10)
		Aesthetic satisfaction VAS score of 9.9 (range: 9-10)
		Grip strength showed an average 10% (range: 0-20) deficit compared to the contralateral hand (tested in patients > 10 years of age)
		Overall, 10 patients had excellent outcomes, while 1 had a good outcome1
Maes et al[21], 2025	12	Full finger ROM was restored after 4 weeks postoperatively	Stable screw positioning without any signs of breakage or loosening- no degeneration at the PIP joint	None	Neither performed nor planned
		At 1 year, finger length growth was normal - no pain - full ROM in all fingers and a symmetrical power grip

¹According to the author’s definition: Excellent outcome if there was complete restoration of normal finger function. Good outcome when both the patient and the surgeon are satisfied; the affected joint has only mild restriction, with no residual deformity.

DASH: Disabilities of the arm, shoulder, and hand; NR: Not reported; VAS: Visual analog scale; ROM: Range of motion; PIP: Proximal interphalangeal joint; DIP: Distal interphalangeal joint; MCP: Metacarpophalangeal joint.