Novel 'mini-incision' metacarpal fixation technique for long oblique and spiral shaft fractures

Metacarpal shaft fractures account for 30 % of all hand fractures, and long oblique and spiral shaft fractures represent a significant quantity. Closed or open reduction and internal fixation is generally indicated for unstable fractures, rotational malalignment or significant metacarpal shortening. Various techniques can achieve appropriate fixation, though no single technique has been proven to be superior across all cases. The choice of fixation often depends on the fracture pattern, surgeon expertise and patient factors.

This large series aimed to show that our novel technique can achieve excellent clinical and aesthetic outcomes for metacarpal fractures despite being inferior in biomechanical studies.

Briefly, 120 fractures in 115 hands were included in centres across Ireland and Saudi Arabia between 2016 and 2022. Inclusion criteria were patients with long oblique and spiral metacarpal mid-shaft fractures with significant displacement, metacarpal shortening and/or rotational malalignment. Fixation was achieved via cerclage wires inserted through a minimal dorsal incision. We examined the clinical and radiological outcomes of these patients.

We observed excellent results in our cohort, with 92.5 % of the patients obtaining full passive and active range of motion at the final follow-up. The mean qDASh score was 4.5. There was 1 case of malunion and 1 wire migration. No patients had cosmetic concerns regarding the dorsal hand scars.

Our novel metacarpal cerclage can help patients regain excellent range of motion and avoid extended immobilisation. We believe that this method is technically simple, forgiving to mistakes, affordable and can provide excellent cosmesis.