Management of metacarpal fractures

Abstract

The metacarpal fractures are common fractures which are treated by orthopaedic surgeons, plastic surgeons and hand surgeons equally. These are seen in young adults who have active life style. These have a major impact in life style of the patients if these are not treated adequately. The management of the fractures vary among surgeons to surgeons; two surgeons in the same centre can have a different treatment plan for a fracture. There are no standard guidelines for the treatment and it ranges from conservative management, Kirschner's wire (K-wires), plates and screws. This review article is about the management of metacarpal fractures where the commonly done procedures are reviewed.

Horizontal (Transverse) Intraarticular Metacarpal Head Fracture in a Young Adult

“…Intraarticular MCP head fractures can be very challenging to recognize on routine radiographs. In addition to standard anteroposterior, lateral, and oblique radiographs, when such fractures are suspected, the Brewerton view is obtained (the MCP joint is flexed 60 to 70 degrees and the X-ray beam is angled 15 degrees from an ulnar to radial direction) [7,8]. [4].…”

“…Most agree that displaced MCP fractures should be treated with internal fixation using minifragment screws, Kirschner wires, pins, or minicondylar plates. The volar approach is more commonly used as it provides better visualization of the metacarpal head and the articular surface [1,[6][7][8][9].…”

Comparative Study Between Intramedullary K Wires Versus Mini-plates and Screws in Fixation of Metacarpal Shaft Fractures in Adults

“…6 The goals of treatment include early diagnosis, anatomical reduction correcting the rotational and deformities, preservation of soft tissue, preservation of the longitudinal and transverse arches, and maintaining length of the metacarpus because shortening of more than 3 mm will lead to an imbalance between the extrinsic and intrinsic hand muscles. 7 Operative fixation of hand fractures has gained increasing popularity 8 due to better materials, implant designs, instrumentation, 9 a better understanding of the biomechanics of internal fixation, availability of subspecialists in hand surgery, ease of anesthesia and improvement of hand physiotherapy methods. 10 Over the last 25 years, treatment of metacarpal fractures have greatly expanded.…”

“…10 Over the last 25 years, treatment of metacarpal fractures have greatly expanded. 8 It can be treated by closed reduction and splinting 11 which have the disadvantage of difficulty to preserve joint mobility to avoid stiffness, 12 Kirschner wires fixation, intraosseous wiring, and screw fixation with or without plating having the advantage of early active motion but carry the disadvantage of wide surgical exposure and soft tissue injury. 11…”

“…reduction with good stabilization that is rigid enough to allow rapid mobilization, but rupture of extensor tendons, stripping of periosteum with affection of nutrition, difficult technique, loosening and distraction of the implant and infection are common problems with mini-plates. 8 Rehabilitation is the most important aspect of treatment. Early motion after fixation of hand fractures is particularly important because tendon gliding and joint mobility are crucial to a well functioning hand.…”