Side-to-Side Metacarpal Fusion for Reconstruction of Bone Loss in the Radial Carpometacarpal Joints

Abstract

We present a unique case of side-to-side metacarpal fusion for reconstruction after an isolated gunshot wound to the right hand of a 19-year-old woman. There was a traumatic segmental loss of the proximal right second metacarpal base with considerable comminution of the trapezium and trapezoid. Reconstructive options were limited because of the destruction of the distal carpus and carpometacarpal (CMC) joint. Digital ray amputation was offered but deferred because of patient preference. The reconstruction was performed via metacarpal fusion of the second metacarpal remnant to the third metacarpal base, bypassing the previously destroyed second CMC joint. The fusion of the second and third metacarpals offers acceptable results when the radial CMC joints are traumatized with extensive bone loss.

Fibular Allograft Osteoplasty and Silicone Arthroplasty following Gunshot Injury of the Metacarpal

“…Although isolated osteoplasty 4,5 and arthroplasty 6 guidelines are widely discussed separately, they are rarely described in combination outside of locally invasive tumor resection. 7,8 This presentation greatly differs from reconstructive considerations in blast injuries because of soft tissue distortion and zone of injury present.…”