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A Simple Technique to Improve the Accuracy of Plaster Molding in Metacarpal Neck Fractures

Chinnusamy, Rajavelu, MBBS, MS (Ortho), MRCS (Ed), MCh (Ortho), FRCS (Tr&Ortho); Boden, Richard, BSc (Hons), MRCS (Eng), FRCS (Tr&Ortho)

doi: 10.1097/BTO.0000000000000217
Tips and Pearls

Metacarpal neck fractures are mostly reduced in A&E or in fracture clinic. Once the cast is applied a simple technique is described to locate the metacarpal head. On the uninjured hand, measurement is taken from the tip of corresponding finger to the metacarpal head. This measurement is transferred on to the cast for further reduction and moulding. This technique provides a reliable outcome.

Lancashire Teaching Hospital NHS Foundation Trust, Preston, UK

The authors declare that they have nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact Rajavelu Chinnusamy, MBBS, MS (Ortho), MRCS (Ed), MCh (Ortho), FRCS (Tr&Ortho), at or by mail at KMCH SULUR Hospital, Trichy Road, Sulur 641402, India. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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Metacarpal neck fractures are mostly reduced in emergency department or in the fracture clinic. Once the cast is applied, it is difficult to locate the metacarpal head for the correct level of molding. This may lead to poor reduction and maintenance of the fracture at the expense of time and effort. We describe a simple technique to improve the accuracy and outcome.

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After initial reduction of the fracture, a short-arm cast is applied with the metacarpophalangeal (MCP) joint in extension. On the uninjured hand, a measurement is taken from the tip of the corresponding finger to the metacarpal head. This measurement is transferred on to the cast (Fig. 1). Further reduction and molding is performed (Fig. 2).





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Biomechanical studies have shown that >30 of angulations of little finger metacarpal neck can result in decreased grip strength and loss of digital motion.1 Protrusion of the volar flexed metacarpal head into the palm may create pain and disability with tight grip.2 This is especially detrimental in manual laborers.2

The optimal and most effective immobilization technique for metacarpal neck fractures remains controversial.3 The findings of Tavassoli and colleagues in their retrospective review of 263 patients contradicts the conventional teaching that the MCP joint must be immobilized in flexion. Advantages of an MCP extension cast are quicker application, better tolerability,2–4 and access for 3-point molding. Compared with an MCP flexion cast, studies have shown that there are no statistically significant differences in grip strength and range of motion at 3 months’ follow-up.3,4 There was no difference in the 4-week postreduction angulations in the lateral or posteroanterior planes.3

We have been using this measurement technique for the past 2 years. We feel that by measuring the correct level of molding, the outcome can be significantly improved due to better reduction and maintenance of fracture. Our technique in MCP extension plaster cast allows for 3-point molding.

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1. Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg. 1997;99:1079–1083.
2. King JC, Nettrour J, Beckenbaugh RD. Traction reduction and cast immobilization for the treatment of boxer’s fractures. Tech Hand Up Extrem Surg. 1999;3:174–180.
3. Hofmeister EP, Kim J, Shin AY. Comparison of 2 methods of immobilisation of fifth metacarpal neck fractures: a prospective randomized study. J Hand Surg. 2008;33A:1362.
4. Tavassoli J, Ruland RT, Hogan CJ, et al. Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments. J Bone Jt Surg. 2005;87A:2196–2201.

metacarpal neck; fracture; reduction; plaster; moulding; technique

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