Low-profile versus conventional metacarpal plating systems: a comparison of construct stiffness and strength

Smaller, lower-profile plates for metacarpal fixation may have the potential to reduce extensor tendon irritation and adhesions, but their sufficiency for stabilizing metacarpal fractures has not been studied. We investigated the relative stiffness and strength of low-profile and conventional plating systems. For apex dorsal bending (bending closed), no plates broke or had notable plastic deformation. The conventional plates exhibited higher overall bending rigidity than all other plates, but had a lower maximum bending moment than the smaller plates. In apex volar bending (bending open) and torsion, the conventional plates were remarkably more rigid and developed remarkably higher torque. In vivo metacarpal loads are primarily apex dorsal bending, and all plates performed well in this mode. Thus, the smaller, low-profile plates may be sufficient for metacarpal fixation, although patient compliance and the use of supplemental stabilization with a cast or splint should be considered.