Metacarpal Shaft Fracture ORIF 26615

Metacarpal shaft fracture xray

Metacarpal shaft fracture ORIF xray

synonyms:metacarpal shaft fracture ORIF, MC ORIF, MC shaft ORIF, metacarpal fixation

Metacarpal Shaft Fracture ORIF CPT

Metacarpal Shaft Fracture ORIF Indications

  • Displaced MC shaft fracture (angulation >30 degrees, shortening >4mm, any rotational deformity)

Metacarpal Shaft Fracture ORIF Contraindications

  • Nondiscplaced fracture
  • Medically unstable patient
  • Active infection

Metacarpal Shaft Fracture ORIF Alternatives

Metacarpal Shaft Fracture ORIF Pre-op Planning

  • Generally 1.5mm or 2.5mm plates.

Metacarpal Shaft 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.
  • Pre-bend plate with gradual 5 degree contour over the entire length of the plate. If plate is not pre-bent the volar cortex will gap open when the plate is secured.
  • Ensure screw purchase in 4 cortices (2 plate holes) on both sides of the fracture
  • 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 Shaft Fracture ORIF Complications

    • Nonuion
    • Infection
    • Painful hardware
    • Compartment Syndrome
    • CRPS
    • DVT / PE
    • Heterotopic Ossification

    Metacarpal Shaft 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 Shaft Fracture ORIF Outcomes

    Metacarpal Shaft Fracture ORIF Review References

    • Rockwood and Greens
    • Greens Hand Surgery