Chapter

Stable Fixation of the Hand and Wrist

pp 52-54

Transverse and Short Oblique Metacarpal Shaft Fractures

  • Alan E. FreelandAffiliated withSection of Hand Surgery, University of Mississippi Medical CenterJackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation Center
  • , Michael E. JabaleyAffiliated withSection of Hand Surgery, University of Mississippi Medical CenterDivision of Plastic Surgery, University of Mississippi Medical CenterSt. Dominic’s-Jackson Health Services Center, Mississippi Baptist Medical Center, River Oaks Hospital, Mississippi Methodist Rehabilitation Center
  • , James L. HughesAffiliated withSection of Hand Surgery, University of Mississippi Medical CenterDivision of Orthopaedic Surgery, University of Mississippi Medical CenterJackson Veteran’s Administration Hospital, Mississippi Methodist Rehabilitation Center, Blake Clinic for Crippled Children and Mississippi Children’s Rehabilitation Center

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Abstract

Transverse metacarpal shaft fractures often result from crush or high-velocity injuries and are accompanied by severe swelling and soft tissue damage even when the fracture is closed (Figs. 16-1 A and 16-2 A). Even though the fracture configuation is stable, satisfactory reduction may not be possible because of soft tissue swelling (Fig. 16-1 B). Open reduction (Figs. 16-1 C, D) may be necessary. The surgeon must decide whether the additional dissection necesary for plate fixation is justified by the considerably increased stability achieved at the fracture site (Figs. 16-1 E-G). With less dissection, a tension band wire with or without neutralizing Kirschner wires may be considered for stabilization of a transverse or short oblique metacarpal diaphyseal fracture (Figs. 16-2 A-C).

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Fig. 16-1 A

This x-ray demonstrates a completely displaced, angulated, and shortened transverse fracture of the diaphysis of the second metacarpal.

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Fig. 16-1 B

There was severe soft tissue swelling, and closed reduction efforts failed.

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Fig. 16-1 C

An S-shaped incision was used in this instance.