Metacarpal Fracture Closed Reduction and Pinning

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TECHNIQUE VIDEO
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TECHNIQUE STEPS
 
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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case

2

Description of potential complications and steps to avoid them

F

Room Preparation

1

Surgical Instrumentation

  • K wires

2

Room setup and Equipment

  • standard operating table
  • hand table

3

Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity
G

Closed Reduction

1

Perform a closed reduction

  • flex the MCP joint to obtain control of the distal fragment
H

K Wire Placement

1

Place the K wire

  • place a 0.045 inch smooth K wire by hand on the radial or ulnar collateral recess

2

Check placement using fluoroscopy

  • confirm that the placement is at the deepest concavity of the collateral recess
  • take an oblique or near true lateral view to confirm placement of the pin in the sagittal plane
I

Wire Advancement

1

Advance the wire to the fracture site

  • advance the wire using power into the shoulder of the metacarpal down the intramedullary canal up to the fracture site

2

Reduce the fracture

3

Advance the wire past the fracture site

  • make sure that it stays in the intramedullary canal

4

Seat the wire in the bone of the metacarpal base

  • another option for advancement is to use a mallet instead of power
  • this allows bounce off of the far cortex
J

Passage of Second Wire

1

Pass a second wire

  • this completes and strengthens the fracture stabilization
  • reduction and fixation is optimum when both wires cross the fracture site
Postoperative Patient Care
 

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