Indications

Most metacarpal fractures are amenable to closed reduction and plaster immobilization. Definite indications for operative treatment include (Fig. 7.4.1):

• Open fractures.

• Multiple fractures (stabilizing effect of the adjacent metacarpals is lost).

• Unstable fractures (border metacarpals).

• Fractures with rotational malalignment (spiral and oblique fractures).

• Fractures in polytrauma victims (early mobilization required).

Preoperative planning

Clinical assessment

• Pain, swelling and ecchymosis around the metacarpus.

• Assess and document neurovascular status.

• Assess and document rotational alignment, axis and range of motion of fingers.

Radiological assessment

• Anteroposterior, lateral and oblique views.

• A 30-degree pronated lateral view for second and third metacarpals and a 30-degree supinated lateral view for fourth and ith metacarpals are helpful.

Preoperative consent

• Obtain informed consent from the patient, including but not limited to risks, beneits, alternatives, complications and potential outcome.

Operative treatment

• The World Health Organization (WHO) Surgical Safety Checklist should be used in the operating room.

Anaesthesia

• Regional or general anaesthesia.

• Preoperative prophylactic antibiotics as per local hospital/unit protocol.

Table and equipment

• Hand instrumentation set.

• Small or mini-fragment instrumentation set.

• Arm table.

• Pneumatic arm tourniquet.

• Fluoroscopic C-arm.