Case Study: Closed Reduction and Internal Fixation of the
Fifth Metacarpal performed to 24 year-old male plumber

The patient has been in our office with complaints of right-hand pain over a week now. The patient remembers the fall injury. The pain is moderate in intensity. The patient describes the pain as throbbing, aching. The pain is constant and does disturb sleep.

The pain is associated with swelling, numbness, tingling, radiating pain, weakness. The problem has been unchanged since it started. Nothing makes the symptoms better. The patient has not undergone surgery for the same in the past. The patient is right-handed.

The patient is currently working as a plumber. To perfect their trade, plumbers need to have good manual dexterity. This includes the capacity to maintain balance with the arm and hand while supporting a tool or piece of pipe, the capacity to operate small objects with the fingers, and the capacity to coordinate the actions of both hands.

Xray were presented and showed impression as follows: Reidentification of a mildly angulated transverse fracture middle one third right fifth metacarpal. An overlying cast is present.

We tried a closed reduction hematoma block, but this reduction could not be achieved. We discussed treatment options with the patient and the patient opted for surgical management.

We discussed risks and benefits including infection, bleeding, nonhealing, need for repeat surgery, hand stiffness, chronic regional pain syndrome among others. The patient understood and signed an Informed consent.

The patient was taken to the operating room where general anesthesia was induced. The right upper extremity was prepped and draped aseptically in the usual fashion after tourniquet application. Preoperative antibiotic was already given.

Anterior portal was made by checking it with C-arm proximal to the base of the metacarpal. A pin was introduced with an introducer into the shaft. The pin progressed further through the fracture into the hand. Finding in an acceptable position. A second pin was introduced to achieve provisional stability.

The pin was similarly introduced on the plate and crossed to the fracture into the hand. Both pins were in satisfactory condition. Both pins were bent and cut at the base.

The pins were undermined under the skin and closure was done using nylon. A dressing was done using 4×4 and Webril and an ulnar gutter splint was applied with ease. The patient was extubated and moved to recovery in a stable condition.

After two weeks post-operative, the patient came in with his Xray result. Two pins traverse a nondisplaced fracture middle one third right fourth metacarpal. Mild callus formation is noted. Fracture line is still appreciated.

An overlying cast is present. There are no subluxations nor dislocations. There are no radiopaque foreign bodies. Mild soft tissue swelling is noted. Healing fracture right fifth metacarpal, as above.

General Appearance: no swelling, tenderness, or warmth and wound clean and dry (small area of redness), appropriate range of motion, and neurovascular intact. Patients get well after surgery with consistent follow up checkups.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

Dr Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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