Procedure 55 Metacarpal Shaft Fractures
See Video 39: Metacarpal Shaft Fractures
Examination/Imaging
Clinical Examination
Surgical Anatomy
Metacarpals can be easily accessed through the dorsal approach (Fig. 55-1).
The extensor tendons are surrounded by paratenon and can be easily separated by dividing the juncturae tendinum that interconnect them at the level of the metacarpal necks (Fig. 55-2).
Exposures
A longitudinal incision is marked along the dorsum of the metacarpal. The incision is centered over the fracture and equals the length of the plate.
In open injuries, the open wound is incorporated in the incision and excised as needed.
For fixation of multiple fractures, two incisions on the dorsum in the second and fourth web space will provide access to adjacent metacarpals and allow decompression of the interosseous compartments if needed. Alternatively, a transverse incision across the back of the hand may be used as an extension of a preexisting traumatic wound (Fig. 55-3).
After spreading dissection, the extensors are exposed and retracted (Fig. 55-4).
Pearls
For plating of adjacent metacarpals, a single skin incision between the metacarpals will allow access to both fractures (Fig. 55-5).
Careful spreading dissection is necessary after skin incision to preserve subcutaneous nerves and veins.
Paratenon around the extensor tendons must be preserved to minimize postoperative tendon adhesions.
Juncturae tendinum between tendons may need to be divided to facilitate retraction of the extensor tendons.
In case of excessive comminution, periosteum around the fracture is left intact, and the implant is secured distally and proximally. Figure 55-6 shows the bridge plating technique used in a comminuted metacarpal fracture due to a gunshot wound.
Procedure
Step 1: Principles and Methods of Fixation
In oblique and spiral fractures, achieve provisional reduction and stabilize with a K-wire (Fig. 55-7).
Type of fixation depends on the fracture geometry.
Transverse fractures are treated with compression plating (Fig. 55-8).
Related posts:
28: Pronator Teres Rerouting
34: Reconstruction of the Central Slip with the Transverse Retinacular Ligament for Boutonnière Deformity
32: Crossed Intrinsic Tendon Transfer
26: Reconstruction of Key Pinch in Tetraplegia Patients
33: Correction of Swan-Neck Deformity in the Rheumatoid Hand
30: Synovectomy
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
