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The Classic: Internal Splinting of Fractures of the Fifth Metacarpal

Bosworth, David, M

Section Editor(s): Meals, Roy A MD, Guest Editor; Harness, Neil G MD, Guest Editor

Clinical Orthopaedics and Related Research: April 2006 - Volume 445 - Issue - p 3
doi: 10.1097/01.blo.0000205881.35587.e2
SECTION I: SYMPOSIUM: Problem Fractures of the Hand and Wrist
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(The Classic Article is ©1937 by The Journal of Bone and Joint Surgery and is reprinted with permission from Bosworth DM. Internal splinting of fractures of the fifth metacarpal. J Bone Joint Surg. 1937;19:826-827.)

Correspondence to: Henry H. Sherk, MD, Drexel University College of Medicine, Orthopaedic Surgery, 245 N. 15th St. 7th Floor (MS420), Philadelphia, PA 19102. Phone: 215-762-4471; Fax: 215-762-3442; E-mail: Henry.Sherk@DrexelMed.edu.

David M. Bosworth was born in New York City in 1897. He received AB and MD degrees from the University of Vermont and was an intern at the Mary Fletcher Hospital in Burlington, Vermont in 1921. There he met Dr. Mather Cleveland who at that time was an instructor in surgery at Columbia University College of Physicians and Surgeons in New York City. Dr. Cleveland persuaded Dr. Bosworth to return to New York to take further training in surgery and orthopaedics. Eventually Dr. Bosworth became an orthopaedic resident at the New York Orthopedic Hospital under Dr. Russell Hibbs. Thereafter Bosworth served on the staffs of Saint Luke's Hospital in New York, the Seaview Hospital in Staten Island, NY, and the House of Saint Giles the Cripple in Brooklyn, NY. Dr. Bosworth was President of the American Orthopaedic Association in 1957. He was best known for his work on the surgical treatment of tuberculosis in the years in which streptomycin and isoniacid first appeared but he had wide-ranging interests. The paper presented here as the Classic Article for the problem hand fractures symposium is indicative of the breadth of these interests. Dr. Bosworth died in 1979.

Henry H. Sherk, MD

The usual result of fracture of the head of the fifth (or other) metacarpal is unfortunate both in its roentgenographic and clinical aspects. Rarely is extension of the distal short fragment maintained. Generally union occurs in marked flexion and the prominence of the knuckle is lost. Because of the flexion, a defect persists in extension of the metacarpophalangeal joint. It is true that well-applied and well-maintained extension will generally prevent this, but it does not always do so, and it disables the patient as regards the use of the hand for three weeks and frequently longer.

Recently the pathologist at Sea View Hospital had the misfortune to suffer a fracture of the fifth metacarpal (figure not shown). In this case it was necessary to devise a better, simpler, and less handicapping method of treatment than had been used in the past, and the idea of splinting the distal fragment of the fifth to the fourth metacarpal occurred to the author.

Under strict asepsis and with the use of the fluoroscope, the writer manipulated the fracture into the best position obtainable (it was three weeks old), and then guided his assistant in drilling two wires at angles through the distal fragment of the fifth metacarpal into the fourth metacarpal. When these wires had been placed, the fracture was perfectly immobilized and the patient was able to move all fingers of this hand without restraint or difficulty.

The wires were clipped off a quarter of an inch outside the skin and a dressing, wrung out of Dakin's solution, was placed around and over them and strapped in place with adhesive. This small dressing was left in place for three weeks and then it and the pins were removed. Both pins were found very tightly set in the bone at that time, no absorption having taken place around them. The prominence of the knuckle was well maintained. This patient had meanwhile been able to continue with his full duties as pathologist without pain or loss of the use of any of his fingers. In a second case (figures not shown) the pins were placed differently. One was drilled through the proximal fragment to hold it forward and the other through the distal fragment to force it backward. Stability in this case was not nearly as good and the distal fragment rotated on the wire, so that the prominence of the knuckle was not as well maintained.

Several other cases have since been treated by the first method with uniformly successful results.

© 2006 Lippincott Williams & Wilkins, Inc.