Osteotomy of the metacarpals and phalanges stabilized by AO plates and screws

Although digital or metacarpal nonunion with resultant functional disability of the hand is encountered often enough that corrective osteotomy becomes a consideration, many surgeons are reluctant to attempt osteotomy in the hand. This reluctance is reflected in the sparse number of cases reported in the literature. Since the effectiveness of AO plates and screw fixation for acute phalangeal and metacarpal fractures is well established, it seems logical to perform osteotomies in phalanges or metacarpals and stabilize them in the same fashion. We have reviewed 36 such osteotomies from the files of the AO Documentation Center. The osteotomies were done through either phalanges or metacarpals to correct angulation and/or rotary malunion, and yielded twenty-three very good, eight good and five poor results, or an overall satisfactory result rate of 86%. All osteotomy sites healed and the poor results reflect persistent deformity or limited adjacent joint motion. Thus, it appears that previously expressed pessimism regarding potential non-union or joint stiffness following phalangeal or metacarpal osteotomy is not warranted in angular and/or rotational osteotomy in the hand can yield satisfactory results in a very high percentage of patients.