Flexible intramedullary nailing for metacarpal fractures

A 5-year retrospective review of 83 patients with 98 metacarpal fractures was performed. Fractures of the thumb metacarpal were excluded. Ninety-six closed metacarpal fractures were reduced closed and fixed with flexible intramedullary fixation, using multiple 0.8-mm prebent rods. Two open metacarpal fractures were also fixed with this technique. Fractures amenable to flexible intramedullary fixation include short oblique and transverse fractures. Contraindications include long oblique and bicortical comminuted fractures. The average follow-up time was 9 months (range, 2 to 34 months) with 15 patients lost to follow-up examination. All fractures went on to heal. Three complications occurred: backing out of a rod in one case and bending of the rods after repeat trauma in two. There were no infections. Flexible intramedullary nailing of specific metacarpal fractures affords excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.