Internal fixation of metacarpal shaft fractures using Synthes® 20 mm Modular Hand System
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Metacarpal fractures are amongst the commonest injuries in the hand and if either malunited or managed sub-optimally can result in significant disability. Internal fixation of these injuries allows more rapid rehabilitation, so important in the recovery of dexterous hand function.
Conventional wisdom has always advocated a minimum of three bicortical screws on either side of the fracture for a stable construct. However, penetration of the drill across the opposite cortex can cause iatrogenic injuries to the closely associated soft tissue structures in the hand. Recent biomechanical studies by Liodaki et al showed that unicortical plating in the metacarpals might provide adequate strength and stability based on cyclical loading. This technique can avoid the risk of drill and screw penetration across the far cortex. Similar biomechanical studies have confirmed the utility of unicortical screws in the cervical spine (Muffoletto AJ et al), the sacrum (Smith SA et al), femur (Beingessner D et al) and the clavicle (Croley JS et al).
This is a step-by-guide for unicortical fixation of a metacarpal fracture using the Synthes ®2.0 mm Modular Hand System.
Author: Manish Gupta, Consultant Hand Surgeon.
Institution: University Hospitals Birmingham NHS trust, Birmingham, UK.