Trauma · Hand

Metacarpal ORIF

Plate, screw, or pin fixation of a displaced metacarpal fracture in the hand to preserve alignment and finger motion.

Overview

Palmar dissection of the hand and wrist showing the eight carpal bones, flexor tendons, and median and ulnar nerves.
Hand and wrist anatomy. Eight small carpal bones form the wrist and connect the forearm to the five metacarpals of the palm. Finger tendons and the median and ulnar nerves pass through narrow tunnels in the wrist on their way into the hand.
Wilfredor · Wikimedia Commons · CC BY-SA 3.0

Metacarpals are the long bones of the hand between the wrist and the fingers. Many metacarpal fractures — especially boxer's fractures of the fifth metacarpal neck — heal well with a short period of immobilization. Surgery is considered when alignment cannot be held, when the fracture rotates the finger, or when multiple bones are involved.

The most important clinical finding is rotational alignment: when the fingers are flexed, they should all point toward the scaphoid. Any rotational malalignment is a strong indication for surgical correction regardless of the X-ray angle.

Why it's done

Metacarpal ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Rotational malalignment

    Crossover or scissoring of the finger during flexion.

  2. Significant angulation or shortening

    Beyond accepted limits for the specific metacarpal.

  3. Open fracture

    Urgent surgical irrigation and stabilization.

  4. Intra-articular fracture

    Step-off at a knuckle joint requires reduction.

  5. Multiple metacarpal fractures

    Loss of the hand's stable arch justifies operative fixation.

How it works

AP hand X-ray showing a Bennett fracture at the base of the thumb metacarpal fixed with a single screw.
Post-op metacarpal fixation. The thumb-base fracture shown here is held with one cortical screw; shaft fractures of the index through little-finger metacarpals are usually held with small plates or percutaneous pins depending on the break pattern.
Wikimedia Commons · CC BY-SA 4.0

Options include percutaneous pinning with smooth K-wires, intramedullary screw or nail techniques, and formal open plate-and-screw fixation. The choice depends on fracture location, comminution, and surgeon preference.

For shaft fractures, a small dorsal incision exposes the bone; a low-profile plate is applied and secured with screws. Pin fixation is often performed percutaneously under fluoroscopy with a small stab incision.

Recovery

The hand is protected in a splint for the first week or two, with finger motion started early to prevent stiffness. Hand therapy is important. Pin removal, when pins are used, is usually at four to six weeks in the clinic. Full strength returns by three months. Stiffness and tendon adhesion are the most common complications.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: