Safety of intramedullary headless screw fixation for pediatric hand fractures: A systematic review
Year: 2026
Type: review
Study design: 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: = 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.
DOI: 10.5409/wjcp.120900
Authors: Ahmed A Khalifa, Ahmed A Megahed, Ahmad Imran
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7163136290