Safe approach for fixation of first metacarpal fractures: an anatomical study

Abstract

This anatomical study defines a safe zone for percutaneous or minimally invasive fixation of first metacarpal fractures in order to avoid injury of the superficial branch of the radial nerve and the dorsal branch of the radial artery. The courses of the nerve and artery branches were marked in 20 embalmed cadaver specimens. With computer-assisted surgical anatomy mapping, a large diversity in the anatomical patterns for the nerve and a consistent pattern for the artery were found. Based on these findings, we conclude that transfixation of the first and the second metacarpals with K-wires placed in the distal 75% of both the first and second metacarpals is the safest way to avoid damages to the nerve and artery branches during fracture fixation.

Comparison of Closed and Open Surgical Technique for Second to Fifth Metacarpal Shaft Fractures: A Multicenter, Retrospective Study in a Dutch City Population

“…A randomized clinical trial would be difficult for multiple reasons. The current study is an extension of the retrospective study by Greeven et al [16,17], adding an additional 89 patients to the 142 presented in the unpublished chapter of this thesis. The current study was, therefore, designed to confirm the results of the previous review to substantiate these results in a large comparative dual-center study and, therefore, confirm that the closed percutaneous technique can be safely used in the treatment of metacarpal shaft fractures of the second to fifth rays.…”