Intramedullary fixation of metacarpal fracture using the Acutrak compression screw
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Metacarpal neck fractures are very common in the hand. The “Boxers” fracture of the 5thmetacarpal neck being one of the commonest injuries that presents to a Hand surgeon. Most of these injuries can be treated conservatively and heal satisfactorily with no functional deficit. However, some present with rotational deformities that need correction for an optimal outcome. A handful of these also present with other concomitant injuries in the hand, which cannot undergo appropriate rehabilitation until the metacarpal neck fracture has been adequately stabilized.
Many surgical techniques have been described for reduction and stabilization of this fracture with varied risks and benefits. Open fixation with plates and screws affords the most reliable reduction and a stable construct for immediate mobilization. However, tendon adhesions and stiffness are a significant potential complication. This is a step-by-step guide of a novel technique to achieve rigid stabilization with a minimally invasive approach and an intramedullary fixation. The procedure is minimally invasive and the intramedullary location of the implant minimises risks of tendon adhesions.
Author:Manish Gupta FRCS.
Institution: Consultant Hand Surgeon, Queen Elizabeth Hospital, Birmingham, UK.