Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands

The most common fracture of the hand occurs at the neck of the metacarpal. Despite clinical studies, controversy remains as to how much fracture angulation should be tolerated before more aggressive reduction is required. A controlled biomechanical model was used to simulate fifth metacarpal head fractures in fresh human cadaveric hands. Fracture angulation was varied from 0 to 90 degrees at 10-degree intervals. We measured tendon excursion, tendon load, and work required to flex the small finger from full extension to full flexion with 10-degree incremental increases in vertex-dorsal angulation. Repeated measures analysis of variance revealed a significant decay in the efficiency of the flexor system when fracture angulation exceeded 30 degrees. Tendon excursion, load, and work requirements were all increased, confirming the detrimental effect of excessive fracture angulation on hand mechanics and function.