Metacarpal Neck Fracture ORIF / CRPP

synonyms:

Metacarpal Neck Fracture ORIF CPT

• 26615 (open treatment metacarpal fracture, single, with or without internal or external fixation, each bone)
• IM fixation 26608 or 26727 if done percutaneously and fracture site is not opened.

Metacarpal Neck Fracture ORIF Indications

• Small finger apex dorsal angluation >50°
• Ring finger apex dorsal angultion >30°
• Middle finger apex dorsal anglgutlaiton >15°
• Index finger apex dorsal angulation >10°

Metacarpal Neck Fracture ORIF Contraindications

• Nondiscplaced fracture
• Medically unstable patient
• Active infection

Metacarpal Neck Fracture ORIF Alternatives

• Intrameduallary nails (Gonzalez MH, CORR 1996;327:47)
• Mini-external fixation. (Freeeland AE, CORR, 1987;214:93)
• Non-operative management

Metacarpal Neck Fracture ORIF Pre-op Planning

• Hand Fracture Case Card.
• Fixation must be strong enough to allow early ROM to limit extensor tendon adhesions.

Metacarpal Neck 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.
• Mini-condylar plate placed dorsally. May be placed radially on 2nd metacarpal, ulnarly on 5th metacarpal. Pre-bend plate as need to prevent gapping in opposite cortex.
• 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 Neck Fracture CRPP Technique

• C-arm, pre-op antibiotics
• Fx reduced using Jahss Reduction Maneuver. (MCP joint flexed 70-90 degrees. Proximal fragment is compressed in a palmar direction while the metacarpal head is pushed dorsally.) (Jahss SA, JBJS 1938;20:178)
• Two 0.045 k-wires placed in the collateral recesses of the MC head across fx and into subchondral bone of MC base for 3-4 weeks.
• "splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)