chapter  29
4 Pages

Arthroscopic Treatment of Metacarpophalangeal Joint Fractures in the Hand

Arthroscopic stabilization of intra-articular fractures is a tech-

nique that is widely accepted for the treatment of fractures of

the knee, shoulder, and wrist. Very little has been published

regarding the use of these techniques for the small joints in the

hand. It has only been in the past decade that reports have

surfaced regarding the use of arthroscopy to treat fractures in

the hand (1). This has corresponded largely to the development

of smaller arthroscopes (1.9 mm) and smaller instrumentation.

Techniques to stabilize intra-articular fractures of the hand

stress the importance of anatomically restoring the joint

surface within less than 1 mm of step-off (2,3). For fractures

of the metacarpophalangeal joint this traditionally has required

an open approach that necessitated mobilization of the

surrounding tendons and a capsulotomy to permit visual-

ization. Unfortunately a common response to arthrotomy in

the digits is stiffness, devitilization of bone fragments, and

delayed healing (4). These adverse effects have focused atten-

tion towards alternative, less invasive ways to stabilize these

uncommon but difficult fractures. The assistance of arthroscopy

provides superior visualization through magnification and the

ability to manipulate small articular fragments into place while

limiting the insult to the surrounding soft tissue.