Updated: 10/9/2017

Metacarpal Neutralization Plate with Lag Screw Fixation for Short Oblique Fracture

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Preoperative Patient Care

A

Outpatient Evaluation and Management

1

Obtain focused history and performs focused exam

  • concomitant and associated orthopaedic injuries
  • differential diagnosis and physical exam tests

2

Prescribes and manages nonoperative treatment

  • orders appropriate orthosis

3

Makes informed decision to proceed with operative treatment

  • documents failure of nonoperative management
  • describes accepted indications and contraindications for surgical intervention

4

Provides postoperative management and rehabilitation

  • 2 week postoperative visit
  • remove sutures
  • check for consolidation on radiographs
  • diagnose and management of early complications
B

Advanced Evaluation and Management

1

Provides post-op management and rehabilitation

C

Preoperative H & P

1

Perform basic medical and orthopaedic history and physical

  • check neurovascular status
  • check range of motion

2

Perform operative consent

  • describe complications of surgery including
  • malunion
  • delayed union or nonunion
  • pin site or surgical wound infection
  • extensor tendon adhesions or ruptures
  • MCP or interphalangeal capsular contractures

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

  • Neutralization plate and lag screws

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

Longitudinal Dorsal Incision

1

Mark and make the incision

  • ensure that the exposure allows fixation of four cortices to the fracture both proximally and distally

2

Identify the neurovascular structures

  • identify and protect the dorsal sensory nerve branches
H

Provisional Fixation

1

Place a reduction clamp

  • place a reduction clamp for provisional fixation
  • if the fracture geometry permits , place a 2.0 to 2.5 mm contoured plate over the fracture
I

Plate and Lag Screw Fixation

1

Place a neutralization plate

  • if the fracture geometry permits , place a 2.0 to 2.5 mm contoured plate over the fracture

2

Place lag screws

  • place a lag screw either alone or through the plate
  • one advantage of placing the lag screw through the plate is that it minimizes the amount of soft tissue dissection along with improves stability

3

Place the remaining screws in the plate

  • fill the screw holes in the remainder of the plate
  • standard cortical screws are sufficient
  • in the event that the metaphyseal portion of the bone needs fixation, locking screws can be placed
J

Wound Closure

1

Close the periosteum and soft tissues

  • close the periosteum and the interosseous muscle fascia over the plate
  • this provides a smooth gliding surface for the extensor mechanism

2

Superficial closure

  • close the skin with 3-0 monocryl suture

Postoperative Patient Care

O

Perioperative Inpatient Management

1

Write comprehensive postoperative orders

2

Orders appropriate inpatient occupational and physical therapy

3

Discharges patient appropriately

  • write for pain meds
  • schedule follow up appointment in 2 weeks
R

Complex Patient Care

1

Comprehensive pre-op planning/alternatives.

2

Modify and adjust post-op plan as needed

 

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