INTRAMEDULLARY FIXATION OF METACARPAL AND PROXIMAL PHALANGEAL FRACTURES OF THE HAND

The use of intramedullary fixation for fixation of fractures of the me tacarpal and proximal phalanx is reported. Flexible intramedullary rod s are used for unstable transverse and short oblique diaphyseal fractu res of the proximal phalanx and metacarpal. The fracture site is not o pened and the rods are introduced under xray control, The rods are cut flush with the bone so that there is no soft tissue tethering. Intram edullary spacers are used in comminuted metacarpal fractures associate d with crush injuries and gunshot wounds. The fracture site is opened and a single rod is placed to fill the intramedullary canal. A supplem entary plate may be used to control rotation, and bone graft is usuall y necessary. A new spacer has been designed that has proximal and dist al locking screws to control length and rotation. This also is used ro utinely with bone graft. The techniques outlined stabilize the fractur e site allowing immediate motion postoperatively.