Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section II - Fractures of the metacarpals II–V
from Chapter 6
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Section I Fractures of the first metacarpal
- Section II Fractures of the metacarpals II–V
- Section III Fractures of the phalanx
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF MIDSHAFT FRACTURES OF THE METACARPALS
Indications
Screw and plate fixation is used to stabilize:
(a) Fractures of 2 or more metacarpal bones.
(b) Fractures irreducible by closed reduction.
(c) Open/comminuted fractures.
(d) Fractures with rotational mal-alignment.
(e) Angulation of more than 30?.
(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.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 104 - 108Publisher: Cambridge University PressPrint publication year: 2006