synonyms: Metacarpal Neck Fracture ORIF / CRPP, MC neck ORIF, MC neck fracture fixation
Metacarpal Neck Fracture ORIF CPT
Metacarpal Neck Fracture ORIF Indications
- Small finger apex dorsal angluation >50°
- Ring finger apex dorsal angultion >30°
- Middle finger apex dorsal anglgutlaiton >15°
- Index finger apex dorsal angulation >10°
Metacarpal Neck Fracture ORIF Contraindications
- Nondiscplaced fracture
- Medically unstable patient
- Active infection
Metacarpal Neck Fracture ORIF Alternatives
Metacarpal Neck Fracture ORIF Pre-op Planning
- Fixation must be strong enough to allow early ROM to limit extensor tendon adhesions.
Metacarpal Neck Fracture ORIF Technique
- Sign operative site.
- Pre-operative antibiotics, +/- regional block.
- General endotracheal anesthesia
- Supine with hand table, tourniquet high on the arm. All bony prominences well padded.
- Prep and drape in standard sterile fashion.
- Dorsal longitudinal incision over affected metacarpal. If two metacarpals use single incision between them.
- Fracture exposed by subperiosteal dissection from lateral side of extensor tendon to mimize tendon adhesion.
- Mini-condylar plate placed dorsally. May be placed radially on 2nd metacarpal, ulnarly on 5th metacarpal. Pre-bend plate as need to prevent gapping in opposite cortex.
- Consider cancellous bone graft from proximal ipsilateral ulna, distal radius, or iliac crest if needed. (May compress in syringe for firmer graft)
- Close in layers.
- Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)
Metacarpal Neck Fracture CRPP Technique
- C-arm, pre-op antibiotics
- Fx reduced using Jahss Reduction Maneuver. (MCP joint flexed 70-90 degrees. Proximal fragment is compressed in a palmar direction while the metacarpal head is pushed dorsally.) (Jahss SA, JBJS 1938;20:178)
- Two 0.045 k-wires placed in the collateral recesses of the MC head across fx and into subchondral bone of MC base for 3-4 weeks.
- "splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)
Metacarpal Neck Fracture ORIF Complications
- Cosmetic deformity
- Stiffness / tendon adhesions
- Hardware failure
- Complex regional pain syndrome
CRPP Complications=delayed union, malunion, pin tract infection, migration, wire breakage
Metacarpal Neck Fracture ORIF Follow-up care
- Post-op: Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)
- 7-10 Days: remove splint. Place in removable splint with fingers buddy-taped. Encourage gentle ROM
- 6 Weeks: Check xrays. Progress with ROM exercises. Activity modifications: no heavy manual labor, no contact sports, no lifting >5 lbs.
- 3 Months: Check xrays. If union is complete return to full activities. Assess motion, consider occupational therapy if indicated.
- 6 Months: Assess motion,
- 1Yr: F/u xrays, assess outcome.
Metacarpal Neck Fracture ORIF Outcomes
Metacarpal Neck Fracture ORIF Review References
- Rockwood and Greens
- Greens Hand Surgery