Fractures and Dislocations of hand/wrist/forearm/elbow/upper arm and shoulder 

Poster Board Number: PE212 
Location: Hall E 
Moscone Convention Center 

Hand & Wrist 
Jorge L. Orbay, MD Miami FL 
(D – Hand Innovations) 
Alejandro Badia, MD Miami FL 
Igor R. Indriago, MD Miami FL 
Roger K. Khouri, MD Miami FL 

Purpose: Metacarpal fractures are common but consensus on the best mode of treatment has not been established. For severely displaced fractures, open reduction and internal fixation with plates or screws is commonly performed. Unfortunately, extensor tendon adhesions and/or unsightly scars frequently follow this form of treatment. Flexible Intramedullary nailing of these fractures, with multiple small pins, has been described. The method is not popular because it is technically demanding. We have performed flexible Intramedullary nailing of metacarpal fractures utilizing a single, large nail and a simplified method of percutaneous insertion. Methods: We treat extra-articular metacarpal and phalangeal fractures with percutaneously inserted anterograde nails. Our method utilizes flexible nails (.062 and .045) and closed fluoroscopically assisted reduction. Metacarpal Phalangeal joint flexion block splinting is used for four weeks and the nails are routinely removed in the office after fracture healing. Results: We have collected 140 patients with metacarpal or phalangeal fractures treated with this method. We have 119 metacarpal fractures and 41 phalangeal. All fractures healed. Patients have no rotational deformities. All patients returned to previous occupation. Metacarpal fractures recovered full range of motion. Phalangeal fractures presented more serious challenge. Average total active motion for phalangeal fractures was 210°. Complications are infrequent and can be treated successfully. Conclusion and Significance: Our experience with this technique is very favorable as it avoids exposure of the fracture, dissection around the extensor mechanism and scar problems. It obtains excellent functional results and has a low complication rate. 
Wednesday, February 28 10:00 AM – 7:00 PM
Thursday, March 1 through Saturday, March 3 7:30 AM – 5:00 PM
Sunday, March 4 7:30 AM – 12:30 PM
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