Unstable metacarpal and phalangeal fracture treatment with screws and plates.

Plate and screw fixation of the metacarpals and phalanges has limited indications but can provide crucial assistance to the reconstructive hand surgeon in the treatment of complex fractures. Screws are indicated for unstable, long oblique or spiral fractures of the metacarpals and phalanges, intraarticular fractures with articular surface involvement in excess of 25% with or without comminution, and intraarticular condylar, T-condylar, and Y-condylar fractures. Plates at the metacarpal level are indicated for segmental defects with substance loss, fractures with extreme comminution, and unstable short oblique or transverse diaphyseal fractures. Plate fixation of phalangeal fractures is seldom necessary but helpful in treating segmental defects or extreme comminution of diaphysis or metaphysis as well as intraarticular T- or Y-condylar fractures. Screw and plate fixation at the metacarpal levels, when appropriately applied, renders rigid osteosynthesis while inflicting little to no interference on the surrounding soft tissues. Screws can be applied with little to no soft tissue interference throughout the proximal phalanx and proximal and distal aspects of the middle phalanx. Plate fixation for middle phalangeal fractures is limited to salvage situations for preservation of skeletal length. The essentials for successful use of implants are a hand surgeon well versed in a variety of internal fixation techniques including the Association for the Study of Internal Fixation (ASIF) technique of screw and plate fixation, a meticulous respect for, and protection of, the soft tissues, and a facility for delivery of functional aftercare.