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Metacarpal Shaft Fracture ORIF
synonyms:
Metacarpal Shaft 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 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
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
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
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