Release notes of Metacarpals

The content has been revised by Fabio Suarez (CO) and Aida García (CO) with Simon Lambert (UK) as executive editor.

The main differences to the first edition are:

• Update of plating procedures to VA locking plates
• Management of joint dislocation and fracture-dislocation

Pages on the following topics have been added:

• Nonoperative treatment to most of the fracture types
• Intramedullary screw fixation to transverse fractures

The following videos have been added:

• Dorsal Approach to Metacarpo-Phalangeal (MP) Joint of the Finger
• Palmar approach to metacarpophalangeal joint of the finger
• Phalanx—Proximal Fractures—Extension Block Splint (Burke Halter)
• Metacarpal IV—Long spiral fracture—Fixation with two 2.0 mm lag screws
• Metacarpal III—Short oblique fracture—Fixation with a 2.0 mm lag screw and 2.0 mm Variable Angle Adaption plate
• Metacarpal II—Transverse shaft fracture—Fixation with a 5-hole 2.0 mm LCP plate
• Metacarpal V, neck—Subcapital and comminuted fractures—ORIF using 1.5 mm VA Locking Metacarpal Neck Plate
• Metacarpal V, neck—Subcapital and comminuted fractures—Intramedullary splinting with two 1.25 K-wires

The metacarpal material, second edition, includes a detailed description of the following injury types and their management.

Extraarticular fractures of the proximal end segment:

• Nonoperative treatment
• Closed reduction - Splinting
• Compression plating
• Lag-screw fixation with a neutralization plate
• Bridge plating

Partial articular fractures of the proximal end segment:

• Nonoperative treatment
• Closed reduction - Splinting
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate

Complete articular fractures of the proximal end segment:

• Nonoperative treatment
• Screw fixation
• Plating
• Arthrodiastasis with a joint-bridging plate

Dislocations and fracture-dislocations of the carpometacarpal joint:

• Reduction - Immobilization
• ORIF

Simple oblique fractures of the diaphysis:

• Nonoperative treatment
• Closed reduction - Splinting
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Compression plating with/without lag screw

Simple transverse fractures of the diaphysis:

• Nonoperative treatment
• Closed reduction - Splinting
• Compression plating
• Intramedullary screw fixation

Wedge/multifragmentary fractures of the diaphysis:

• Closed reduction - Splinting
• Lag-screw and plate fixation
• Bridge plating

Extraarticular fractures of the distal end segment:

• Closed reduction - Splinting
• Lag-screw fixation with a neutralization plate
• Intramedullary K-wire fixation
• Intramedullary screw fixation
• Compression plating
• Bridge plating

Articular fractures of the distal end segment:

• Closed reduction - Splinting
• Collateral ligament reattachment
• Lag-screw fixation
• Screw fixation
• Plating
• Lag-screw fixation with a neutralization plate

Dislocations and fracture-dislocations of the MCP joint:

• Reduction with or without joint transfixation
• ORIF

Approaches:

• Dorsal approach to the metacarpals
• Dorsal approach to the 5th carpometacarpal joint
• Dorsal approach to the metacarpophalangeal joints
• Dorsoulnar approach to the 5th metacarpal base
• Volar approach to the metacarpophalangeal joints
• Dorsal approach to the carpometacarpal joint
• Radial approach to the 2nd metacarpal
• Dorsoulnar approach to the 5th metacarpal

Further reading:

• Patient assessment
• Bone graft addition
• Postoperative treatment
• Complications and technical failures
• References

The content has been created by Renato Fricker (CH), Matej Kastelec (SI), Fiesky Nuñez (VE), and Terry Axelrod (CA) with Chris Colton (UK) as executive editor.

The metacarpal material, first edition, included a detailed description of the following injury types and their management.

Head, subcapital:

• Intramedullary K-wire fixation

Head, intraarticular:

• Screw fixation

Shaft, transverse:

• Nonoperative treatment
• Compression plate fixation

Shaft, oblique:

• Nonoperative treatment
• Lag screw with protection plate
• Lag screw fixation

Shaft, multifragmentary:

• Nonoperative treatment
• Bridge plate fixation

Base, intraarticular

• Plate fixation

Approaches:

• Dorsal approach to metacarpals
• Dorsal approach to 2nd metacarpal
• Dorsal approach to 5th metacarpal
• Dorsal approach to the fifth carpo-metacarpal joint
• Dorsal approach to the MCP joint
• Dorso-ulnar approach to 5th metacarpal base

Further reading:

• References