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)