CC BY-NC 4.0 · Arch Plast Surg 2021; 48(04): 384-388
DOI: 10.5999/aps.2021.00122
Hand/Peripheral Nerve
Idea and Innovation

Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument

Department of Plastic Surgery, Guys’ and St Thomas’ Hospitals, London, UK
,
Paul Dain Park
Department of Plastic Surgery, Guys’ and St Thomas’ Hospitals, London, UK
,
Ricardo Tejero
Department of Plastic Surgery, Guys’ and St Thomas’ Hospitals, London, UK
,
Niklaas Allain
Department of Plastic Surgery, Guys’ and St Thomas’ Hospitals, London, UK
,
Lauren Uppal
Department of Plastic Surgery, Guys’ and St Thomas’ Hospitals, London, UK
› Author Affiliations

Adequate positioning of the hand is a critical step in hand fracture operative repair that can impact both the clinical outcome and the efficiency of the operation. In this paper, we introduce the use of a thermoplastic splint with an added thumb stabilizing component as a means to increase the surgeon’s autonomy and to streamline the patient care pathway. The thermoplastic splint is custom fabricated preoperatively by the specialist hand therapist. The splint is used prior, during, and post operation with minimal modification. The thumb component assists maintaining the forearm in a stable pronated position whilst drilling and affixing metal work. This is demonstrated in the video of removal of metal work and open reduction and internal fixation of a metacarpal fracture.



Publication History

Received: 11 January 2021

Accepted: 27 May 2021

Article published online:
21 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Court-Brown C, McQueen MM. Trauma (orthopaedic surgery essentials series). 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2006
  • 2 Dreyfuss D, Allon R, Izacson N. et al. A comparison of locking plates and intramedullary pinning for fixation of metacarpal shaft fractures. Hand (N Y) 2019; 14: 27-33
  • 3 Kamath JB, Naik DM. et al. Current concepts in managing fractures of metacarpal and phalangess. Indian J Plast Surg 2011; 44: 203-11
  • 4 Papavasiliou T, Lipede C, Chatzimichail S. et al. Development of a customized three-dimensional printed paediatric hand retractor for patient-precise dimensions and enhanced surgical autonomy. J Hand Surg Eur Vol 2020; 45: 982-4
  • 5 Papavasiliou T, Chatzimichail S, Kolaityte V. et al. A novel customized 3D printed arm stand improving skin preparation efficiency in hand surgery. Surg Glob Open 2020; 08: e3249
  • 6 Papavasiliou T, Chatzimichail S, Pafitanis G. Three-dimensional printed microvascular clamps: a safe, cheap, and effective instrumentation for microsurgery training. Plast Reconstr Surg Glob Open 2020; 8: e3107
  • 7 Hansen PB, Hansen TB. The treatment of fractures of the ring and little metacarpal necks: a prospective randomized study of three different types of treatment. J Hand Surg Br 1998; 23: 245-7
  • 8 Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plast Reconstr Surg 2015; 136: 370e-379e
  • 9 Bethel CA, Meller MM. Volar splinting. In:StatPearls [Internet] Treasure Island: StatPearls Publishing; 2020
  • 10 James JI. The assessment and management of the injured hand. Hand 1970; 2: 97-105
  • 11 Wilton JC, Dival TA. Hand splinting: principles of design and fabrication. London: WB Saunders; 1997
  • 12 Toemen A, Midgley R. Hand therapy management of metacarpal fractures: an evidence-based patient pathway. Hand Ther 2010; 15: 87-93