Biomechanical Comparison of Plate Versus Intramedullary Screw Fixation for Extra-Articular Metacarpal Base Fractures

Sep 29, 2026

Intramedullary (IM) screws and dorsal plates are both used for metacarpal fractures, yet their biomechanical performance in extra-articular metacarpal base fractures has not been well established. This study compared IM screw fixation versus dorsal plate fixation in randomized cadaveric metacarpals using cantilever bending. Dorsal plating showed higher ultimate load to failure, while IM constructs demonstrated greater stiffness across specimens. Both methods exceeded expected physiological loading.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Original Research

Purpose

Methods

Results

Conclusions

Clinical relevance

Background and epidemiology

Management options

Journal of Hand Surgery Global Online 8 (2026) 100897 Contents lists available at ScienceDirect Journal of Hand Surgery Global Online journal [homepage:](homepage: www . J HS GO . org)[ www . J HS GO . org](homepage: www . J HS GO . org) Original Research Biomechanical Comparison of Plate Versus Intramedullary Screw Fixation for Extra-Articular Metacarpal Base Fractures Majd Mzeihem, MD, * Dmitriy Peresada, MD, * Yeseop Park, PhD, * Jiries A. Fakhouri, BS, * Danil Rybalko, MD, * Mark H. Gonzalez, MD, PhD, * Farid Amirouche, PhD *,† * Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL † Department of Orthopaedic Surgery, Northshore University Health System, an Affiliate of the University of Chicago Pritzker School of Medicine. Skokie, IL a r t i c l e i n f o Article history: Received for publication October 28, 2025 Accepted in revised form November 1, 2025 Available online xxx Key words: Biomechanics Fracture fixation Hand surgery Intramedullary screw Metacarpal base fracture Purpose: Intramedullary (IM) screws are commonly used for metacarpal shaft and neck fractures, but their application in extra-articular metacarpal base fractures has not been thoroughly evaluated. This study aims to compare the biomechanical performance (load to failure) of IM screw fixation versus dorsal plate fixation for extra-articular fractures at the base of the metacarpal. Methods: Twenty-four cadaveric metacarpals from 12 upper extremities were prepared and randomized to receive either IM screw fixation or dorsal plate fixation following a standardized transverse fracture near the base. All specimens were potted and tested using cantilever bending in a materials testing system. The primary outcome was ultimate load to failure; stiffness was evaluated as a secondary measure. Results: Dorsal plate fixation demonstrated greater load to failure compared to IM screw fixation when all specimens were analyzed collectively. Subgroup analysis indicated this difference was more pronounced in the thumb metacarpals. In contrast, IM screw constructs consistently exhibited greater stiffness across all specimens, including both thumb and small finger metacarpals. Conclusions: Dorsal plating offered greater resistance to fracture displacement, while IM screw fixation provided superior construct stiffness. Both fixation methods surpassed expected physiologic loading during hand use, indicating that either approach may be biomechanically acceptable depending on the clinical context. Clinical relevance: The IM screws may serve as a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures. These findings may help guide surgical decision-making regarding fixation selection and promote individualized treatment strategies. Copyright © 2025, THE AUTHORS. Published by Elsevier Inc. on behalf of The American Society for Surgery of the Hand. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). Metacarpal (MC) fractures represent a considerable portion of hand injuries and account for up to 44% of all hand fractures and 10% of all fractures in the body.1,2 Epidemiologic studies reveal a five times higher prevalence in men, with the highest incidence in the second and third decades of life.3 Proximal MC fractures, which affect the base, are the least common subset of MC fractures (digits 2 − 5) and can be the most complex to treat.4 Corresponding author: Farid Amirouche, PhD, Basic Science Research, Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University HealthSystem, 9669 Kenton Avenue, Skokie, IL 60076. E-mail address: [famirouche@northshore.org](famirouche@northshore.org) (F. Amirouche). In a study of 18,802 MC fractures from the Swedish Fracture Register, 79% of (first) MC fractures were proximal. In contrast,

FAQs

What was the purpose of the study?

To compare the biomechanical performance, measured by load to failure, of intramedullary (IM) screw fixation versus dorsal plate fixation for extra-articular metacarpal base fractures.

How was the biomechanical testing performed?

Twenty-four cadaveric metacarpals were prepared and randomized to receive IM screw fixation or dorsal plate fixation after a standardized transverse fracture near the base, then tested under cantilever bending in a materials testing system.

What were the key results comparing the two fixation methods?

Dorsal plates produced greater load to failure overall, with a more pronounced difference in thumb metacarpals. IM screws showed consistently greater stiffness across all specimens, including thumb and small finger.

What does the clinical relevance suggest for surgical decision-making?

IM screws may be a biomechanically viable alternative to dorsal plates for extra-articular metacarpal base fractures, supporting individualized fixation selection based on clinical context.

Sep 29, 2026

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