Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Corrective osteotomy of metacarpal fracture malunion
Indications
-
One indication is metacarpal malunion with angular, rotational, or shortening deformity, which results in functional deficits.
-
Acceptable limits of each deformity are debatable (suggested indications for primary surgery are reviewed in Chapter 14 Techniques and Fixation of Metacarpal Fractures), but indication for surgery is dictated by functional deficits that may be improved by corrective osteotomy.
Angular deformity
-
Angulation typically occurs in the sagittal plane (dorsal angulation); angulations up to 15 to 30 degrees generally are well tolerated.
-
Angulation in the coronal plane (radial/ulnar) is less well tolerated because small degrees of malunion may lead to angulation of the digit, which interferes with the function of the adjoining fingers.
Malrotation deformity
-
Rotational deformity is not tolerated as well as angular deformity.
-
Malrotation deformity commonly leads to overlap of the digits (so-called “scissoring”).
-
Five degrees of malrotation at the metacarpal level can cause 1.5 cm of digit overlap distally.
Shortening
-
Greater than 6 mm of shortening can lead to an unacceptable extensor lag.
-
Extensors can accommodate for some shortening because of their range of excursion.
-
Every 2 mm of metacarpal shortening results in a 7-degree extensor lag.
Contraindications
Contraindications include metacarpal malunions on radiographic examination that have no functional deficit. Patients often adapt to minor deformities even when they are greater than the standards, indicating the need for primary operative intervention.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here