OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF MIDSHAFT FRACTURES OF THE METACARPALS

Indications

Screw and plate fixation is used to stabilize:

1. (a) Fractures of 2 or more metacarpal bones.

2. (b) Fractures irreducible by closed reduction.

3. (c) Open/comminuted fractures.

4. (d) Fractures with rotational mal-alignment.

5. (e) Angulation of more than 30?.

6. (f) Fractures if early mobilization is required.

Pre-operative planning

Clinical assessment

• Pain and swelling localized over the metacarpus.

• Assess and document neurovascular status of hand.

• Assess and document rotational alignment, axis and range of movement (ROM) of fingers.

Radiological assessment

• Anteroposterior, lateral, and oblique views (Fig. 6.6).

• A30° pronated lateral view for 2nd and 3rd metacarpal fractures and 30? supinated lateral view for 4th and 5th metacarpal fractures are helpful.

Anaesthesia

• Brachial plexus block, intravenous regional anaesthesia or general anaesthesia.

• At induction, administer prophylactic antibiotic as per local hospital protocol (e.g. 2nd generation cephalosporin).

Table and equipment

• Hand surgery instrumentation set.

• Hand small-fragment implant system.

• A radiolucent armtable.

• An upper armtourniquet.

• An image intensifier.

Table set up

• The instrumentation is set up on the side of the operation.

• Image intensifier is fromthe front side of the armtable.

• Check for adequate visualization in 2 planes prior to draping.

Patient positioning

• Supine, supinated armextended on armtable.