Percutaneous versus open nailing for metacarpal shaft fractures
Journal of Hand Surgery Global Online · 19 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Metacarpal shaft fractures are common, and intramedullary nailing is increasingly used, so knowing whether a smaller incision speeds early recovery without harming the extensor tendon is directly relevant to hand surgery practice.
The evidence
This single-surgeon retrospective cohort compared a percutaneous versus an open (trans-sagittal band) approach for retrograde intramedullary nailing of closed metacarpal shaft fractures in 54 adults (56 fractures). The percutaneous group had better total active motion at 2 weeks (248 vs 228 degrees), plus better grip strength and QuickDASH at 1 and 2 weeks, but all differences disappeared by 4 weeks. Twelve-week outcomes were nearly identical (TAM 248 vs 249 degrees), with no extensor lag in either group and a shorter operation in the percutaneous group (9.5 vs 18.6 minutes).
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Retrospective cohortDesign starting point: 29.6
Raised the score
- Adequately powered+6
- Compared against current standard of care+3.4
Lowered the score
- Only 3 months of follow-up−7.9
- Unadjusted comparison−6.8
Methods at a glance
Recorded assessment- Confounding adjustmentUnadjusted only
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerMet
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 29.6
- Unadjusted comparison
- −6.8
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- Only 3 months of follow-up
- −7.9
- Adequately powered
- +6
- A single centre's own patients
- −3.4
- Consecutive enrolment
- +2.5
- Journal prior (not an observed method)
- +0.4
- Final rigour score rounded
- 26 / 100
Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.If the percutaneous approach only speeds recovery for the first two weeks, which patients (for example manual laborers or those needing early return to work) would benefit enough to justify choosing it?
2.How would you counsel a patient about the slightly greater final angulation seen after percutaneous nailing compared with the faster early return of motion and grip?
Original publication title
Percutaneous Versus Open Approach to Intramedullary Nailing of Metacarpal Shaft Fractures: A Comparison of 12 Week Functional Outcomes