ABSTRACT
Options for Repair Methods Although there were numerous superficial abrasions, none communicated with the fractures. External support with a non-weight-bearing device such as a cast or spoon splint should be considered if one or more metacarpal bones are intact, the fractures are not significantly displaced and the biological environment is deemed adequate. Otherwise, internal fixation should be recommended. Intramedullary pinning is one such technique involving small Kirschner wires inserted into holes drilled in the distal ends of the metacarpals. The wires are then advanced proximally across the fracture site. The holes should be rather large as wires are prone to penetrating the palmar cortex. A togglepinning technique can be used where Kirschner
wires are placed distally, then cut 3-4 mm long. The proximal metacarpal segments are toggled onto those protruding segments of pins. Both of these techniques are tenuous and although often successful, they do frequently fail and therefore need to be supported with a cast or splint. Plating of the metacarpal bone provides support and allows early weight-bearing. The major disadvantage is the approach and the cost of implants are much greater than pinning techniques. Regardless of the technique, applying fixation devices to all fractured metacarpals is recommended as multiple fixations support one another.
