Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review
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.
Related
- A comparative study of Kirschner wire intramedullary fixation versus bicortical fixation for metaphyseal-diaphyseal junction fractures of the pediatric distal radius.
- Clinical Outcomes of Single Intramedullary K-Wire Fixation with Figure-of-Eight Suture Augmentation for Ulnar Styloid Base and Distal Ulnar Metaphyseal Fractures
- Lateral-Only Flexible Intramedullary Nailing for Pediatric Tibial Shaft Fractures: An Early Comparative Experience With a Novel Technique to Reduce Symptomatic Implant Prominence
- Lateral-Only Flexible Intramedullary Nailing for Pediatric Tibial Shaft Fractures: An Early Comparative Experience With a Novel Technique to Reduce Symptomatic Implant Prominence
- Preclinical evaluation of a fully threaded biodegradable magnesium alloy headless compression screw for enhanced fixation in small bones
BibTeX
@article{khalifa2026safety,
title = {{Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review}},
author = {Ahmed A Khalifa and Ahmed A Megahed and Ahmad Imran},
journal = {World Journal of Clinical Pediatrics},
year = {2026},
month = nov,
doi = {10.5409/wjcp.120900},
url = {https://doi.org/10.5409/wjcp.120900},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review
AU - Ahmed A Khalifa
AU - Ahmed A Megahed
AU - Ahmad Imran
PY - 2026
DA - 2026/11/03
JO - World Journal of Clinical Pediatrics
DO - 10.5409/wjcp.120900
UR - https://doi.org/10.5409/wjcp.120900
AB - 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.
SN - 2219-2808
ER -