Skin necrosis complicating functional bracing

We report a complication associated with functional bracing of a metacarpal shaft fracture that required operative intervention. A 30-year-old man with a closed, dorsally angulated, metacarpal shaft fracture of the right ring finger was treated with a functional brace. During brace immobilization, the patient developed full-thickness skin necrosis on the dorsum of the right hand. The patient underwent surgical debridement of the ulcerated area and fracture stabilization with an intramedullary Kirschner wire. Patients treated with a metacarpal brace should be instructed to release the strap every 5 to 6 hours for a short period to allow restoration of blood flow to the potentially ischemic skin.