Proximal phalanx fractures are common hand injuries with multiple fixation options. This meta-analysis compared outcomes of closed extra-articular fractures treated with intramedullary screws (IMS), percutaneous pinning (PCP), plating, or lag screws.

A systematic review of MEDLINE, Embase, CINAHL, and Cochrane databases (January 2010–May 2025) was conducted according to PRISMA guidelines. Primary outcomes were complication and revision rates; secondary outcomes included immobilization duration, total active motion [TAM] and grip strength. Data were pooled using random- or fixed-effects models based on heterogeneity. Risk of bias and certainty of evidence were assessed using validated tools.

Eleven studies (19 treatment arms; 403 patients; 528 fractures) were included: IMS ( n  = 104), PCP ( n  = 285), plating ( n  = 100), and lag screws ( n  = 39). Mean age was 39 years; mean follow-up, 16.4 months. IMS had the lowest pooled complication rates (major: 0.96%; minor: 2.1%). Compared with IMS, plating had higher odds of major complications (OR 12.63, 95% CI 1.39–114.7; p  = 0.02), while minor complications were more frequent with lag screws (OR 78.3, 95% CI 4.2–1465.1; p  = 0.005) and PCP (OR 18.6, 95% CI 1.7–199.6; p  = 0.02). Revision rates ranged from 5.8% (IMS) to 10.3% (lag screws), without statistical significance. Immobilization was shortest with IMS (mean difference vs. PCP −3.3 weeks; p  = 0.01). TAM was highest with IMS (231°) but not statistically significant ( p  = 0.6).

Intra medullary screw fixation was associated with lower complication risk and shorter immobilization compared with other fixation methods, likely reflecting the advantages of a minimally invasive, stable construct. As current evidence is limited to short-term outcomes and heterogeneous study designs, further high-quality prospective trials with longer follow-up are needed to validate these findings and to clarify the long-term outcomes of intramedullary screw fixation, including the potential implications of cartilage damage.

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