Metacarpal Head Fractures ORIF

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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

  • headless screws
  • guidewires

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

Incision

1

Mark and make the incision

  • make a longitudinal or curvilinear incision over the metacarpal head

2

Bluntly dissect to the extensor mechanism

H

Soft Tissue Dissection

1

Expose the fracture site

  • split the extensor mechanism
  • longitudinally incise the capsule
I

Fracture Reduction

1

Manipulate the MCP joint

  • flex the MCP joint
  • this will facilitate the exposure of the fracture

2

Reduce the fracture

  • use a dental pick or small pointed reduction forceps to reduce the fracture
J

Provisional Fixation

1

Place guidewires

  • insert guidewires from a cannulated headless screw set
K

Definitive Fixation

1

Place headless screws

  • insert headless screws over the guidewires

2

Confirm placement and reduction

  • check the screw placement and fracture reduction radiographically
L

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

Repair the extensor mechanism

  • close the extensor mechanism with 4-0 nonabsorbable suture

3

Superficial closure

  • close the skin with 3-0 monocryl suture
N

Wound Closure

Postoperative Patient Care
 

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