Transverse and Short Oblique Metacarpal Shaft Fractures

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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).
Fig. 16-1 A

This x-ray demonstrates a completely displaced, angulated, and shortened transverse fracture of the diaphysis of the second metacarpal.
Fig. 16-1 B

There was severe soft tissue swelling, and closed reduction efforts failed.
Fig. 16-1 C

An S-shaped incision was used in this instance.