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Metacarpal Fractures
Posted: Mar 15 2019 #(C101176)
A

Closed 2nd Metacarpal Shaft Fx in 32M

HPI

32-year-old male police officer presents with hand pain following an altercation.

PMH

None

PE

Swelling, tenderness, and prominence of the dorsal mid-shaft 2nd metacarpal. Limited index flexion and extension due to pain.

Poll
1 of 11
1. Would you obtain addition imaging studies to determine treatment?
No, current images are enough
88%
1699/1916
Yes, additional xray (+/- ER oblique , IR oblique, Brewerton view, Roberts view)
9%
187/1916
Yes, CT scan
1%
22/1916
Yes, CT scan AND additional Xrays
0%
8/1916
2. How would you treat this fracture?
Nonoperative
19%
354/1852
Operative
80%
1498/1852
3. If choosing Operative treatment, would you reduce the fracture OPEN (OR) or CLOSED (CR) prior to fixation?
Closed Reduction (CR)
57%
1018/1763
Open Reduction (OR)
38%
673/1763
I would not perform Operative treatment
4%
72/1763
4. If you choose operative Closed Reduction (CR), what FIXATION would you use?
CR- Percutaneous K-wire Cross Pins
39%
696/1752
CR - Intramedullary Fixation
46%
815/1752
CR - External Fixation
2%
37/1752
I would not perform operative Closed Reduction and Fixation
11%
204/1752
5. If you choose operative Closed Reduction (CR) and INTRAMEDULLARY FIXATION, what implant would you use?
IM K-wire
57%
956/1662
IM Screw (e.g., Headless Compression screw)
18%
312/1662
IM Nail
9%
160/1662
I would not perform Closed Reduction Intramedullary Fixation
14%
234/1662
6. If you choose operative Closed Reduction (CR) and INTRAMEDULLARY FIXATION, how would you place your IM implant (Nail, Screw, Wire)?
Antegrade
30%
472/1561
Retrograde
50%
793/1561
Combined Antegrade and Retrograde (for K wire only)
8%
130/1561
I would not perform Closed Reduction (CR) and Intramedullary Fixation
10%
166/1561
7. If you choose operative OPEN Reduction (OR), what FIXATION would you use?
OR - Lag Scews Alone
1%
18/1548
OR - Dorsal Plate and Screws
65%
1014/1548
OR - Intramedullary Fixation
10%
165/1548
OR - Percutaneous K-wire Cross Pins
5%
86/1548
OR - External Fixation
0%
2/1548
I would not perform OPEN reduction and Internal Fixation
16%
263/1548
8. If you choose operative OPEN Reduction (OR) and INTRAMEDULLARY FIXATION, what implant would you use?
OR - IM K-wire
48%
669/1378
OR - IM Screw (e.g., Headless Compression screw)
16%
231/1378
OR - IM Nail
7%
103/1378
I would not perform OPEN reduction Intramedullary Fixation
27%
375/1378
9. If you choose operative Open Reduction (OR) and INTRAMEDULLARY FIXATION, how would you place your IM implant (Nail, Screw, Wire?
Antegrade
16%
213/1306
Retrograde
41%
548/1306
Combined Antegrade and Retrograde
8%
116/1306
From within Fracture
7%
96/1306
I would not perform Open Reduction (CR) and Intramedullary Fixation
25%
333/1306
10. If you choose ORIF Plate & Screws or IM screw/nail), assuming you got good reduction and fixation as seen in the postop radiographs below, what would be your postoperative protocol?
Brace Immobilization with Immediate ROM
40%
548/1361
Brace Immobilization with ROM after 2 weeks
24%
334/1361
Brace Immobilization with ROM after 4 weeks
5%
78/1361
Cast Immobilization with Immediate ROM
6%
91/1361
Cast Immobilization with ROM after 2 weeks
10%
144/1361
Cast Immobilization with ROM after 4 weeks
5%
74/1361
I would not perform ORIF
6%
92/1361
11. If choosing NONOPERATIVE treatment, how would you immobilize this fracture?
Closed Reduction, Removable splint, activity as tolerated
3%
42/1346
Closed reduction with casting x 2 weeks, followed by splinting with ROM
30%
411/1346
Closed reduction with casting x 4-6 weeks
39%
536/1346
I would not perform Nonoperative treatment
26%
357/1346
PROCEDURE #1

Index metacarpal intramedullary screw fixation

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OUTCOMES
Post-procedure P1
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