Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand.

The use of intramedullary fixation for fixation of fractures of the metacarpal and proximal phalanx is reported. Flexible intramedullary rods are used for unstable transverse and short oblique diaphyseal fractures of the proximal phalanx and metacarpal. The fracture site is not opened and the rods are introduced under xray control. The rods are cut flush with the bone so that there is no soft tissue tethering. Intramedullary spacers are used in comminuted metacarpal fractures associated with crush injuries and gunshot wounds. The fracture site is opened and a single rod is placed to fill the intramedullary canal. A supplementary plate may be used to control rotation, and bone graft is usually necessary. A new spacer has been designed that has proximal and distal locking screws to control length and rotation. This also is used routinely with bone graft. The techniques outlined stabilize the fracture site allowing immediate motion postoperatively.