Open Reduction and Internal Fixation of the 5th Carpometacarpal Joint with Bridging Plate using Synthes 15 mm Compact Hand Set
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Punching injuries to the hand are widespread and account for significant attendances to the Emergency department. Axial loading along the metacarpus in a closed fist can result in a fracture-subluxation of the hamatometacarpal joint. These injuries are often missed on routine examination and radiographs. Poorly managed injuries can result in disabling sequelae with pain, deformity and functional loss.
These fracture subluxations can sometimes be managed by manipulation followed by stabilisation in plaster splints. More often, they require surgical intervention with minimally invasive percutaneous wiring. This technique has been described elsewhere on this website. However, occasionally, the fracture fragments are displaced to an extent where simple manipulation is insufficient to regain the normal anatomy. This is a guide for management of this challenging cohort of patients that require open reduction. The technique combines the principles of internal fixation of intra-articular fractures along with the philosophy of distraction ligamentotaxis with a bridge plate.
Readers will also find of use the following OrthOracle techniques:
Closed reduction and K wiring of 5th carpometacarpal fracture-dislocation.
Internal fixation of 5th metacarpal neck fracture (Synthes LCP plate)
Author: Manish Gupta FRCS (Tr & Orth), Consultant Hand Surgeon
Institution: Queen Elizabeth Hospital, Birmingham, UK.
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