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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
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