Effect of Bicortical Interfragmentary Screw Size on the Fixation of Metacarpal Shaft Fractures: A 3-Dimensional-Printed Biomechanical Study

PURPOSE: Spiral metacarpal fractures fixed with 2 non-lagged, interfragmentary cortical screws were tested to failure. The effect of screw size (1.2 mm, 1.5 mm, 2.0 mm, and 2.3 mm) on construct strength was tested in 3-point bending. METHODS: Three-dimensional-printed metacarpal test models were reproduced from computed tomography scans to reduce the confounding variables of bone density and anatomy, often encountered when using cadavers. RESULTS: No significant difference was found between the screw sizes, and the peak failure force was similar. Drill bit fracture and deformation during the insertion of the smallest screw (1.2 mm) as well as model failure during the insertion of the largest screw (2.3 mm) were found in some cases. CONCLUSIONS: Screws of 1.5 mm and 2.0 mm in diameter were of sufficient strength and did not have the issues encountered with smaller or larger screws. Concerns from previous authors regarding intraoperative fracture were consistent with the pre-testing failure of some 2.3-mm models. CLINICAL RELEVANCE: Screws of 1.5 mm or 2 mm appear adequate for the fixation of spiral fracture patterns in metacarpal shafts using bicortical non-lagged technique with a low risk of fixation complications.