You are here

Metacarpal Neck Fracture ORIF / CRPP 26615

Metacarpal neck fracture xray

CRPP metacarpal neck fracture xray

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)
  • Irrigate.
  • 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
  • Nonunion
  • Stiffness / tendon adhesions
  • Hardware failure
  • Complex regional pain syndrome
  • Infection

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