Cerclage wiring of metacarpal fractures

Preventing the deformities of rotation and shortening is essential in the treatment of metacarpal fractures. Maintenance of accurate reduction is often difficult to achieve by cast immobilization or by the more sophisticated techniques that use plates and screws. During a four-year period, 92 of 290 metacarpal fractures were treated by open reduction and internal fixation. Of these, 21 were oblique and spiral fractures that were treated by cerclage wiring. The operation is performed with two to three lengths of No. 24 prestretched stainless steel wire that is tightened around the metacarpal shaft following fracture reduction. Mobilization of the hand is begun ten days following surgery, and full, unlimited use is permitted after six weeks. All 21 metacarpal fractures were followed up until the patient was ready to return to work, which occurred an average of seven weeks after surgery. Seventeen patients had no restriction of range of motion, with normal anatomic restoration of the metacarpal. Three patients lost 15 degrees of total active finger motion, and one had an extension lag of 10 degrees at the metacarpophalangeal joint.