Surgical treatment, hardware removal, and the wide-awake approach for metacarpal fractures

Most fractures are managed nonoperatively. Those displaced unstable fractures require percutaneous fixation of single (or double) intramedullary Kirschner wires. Only large, oblique fractures must be fixed with screws or a plate. Indications for plating metacarpal fractures are limited in multiple unstable shaft or oblique fractures. After internal fixation, the patient actively moves the digits over a limited range under protection. This article reviews indications and techniques of surgical treatment, hardware removal, and the wide-awake approaches for surgery of these fractures.