Locked intramedullary nailing of metacarpal fractures secondary to gunshot wounds

Abstract

Purpose: To investigate the results of fixation of 10 metacarpal shaft fractures secondary to low-velocity gunshot wounds with locked intramedullary nails.

Methods: We reviewed the results of 10 patients with locked intramedullary nailing of the metacarpal for low-velocity gunshot wounds. Autogenous bone grafting was used in 9 of the 10 fractures. The follow-up period averaged 26 months. The parameters evaluated included angulation, rotational alignment, shortening of the digit, postoperative metacarpophalangeal (MCP) range of motion, and time to union.

Results: Nine of 10 fractures showed corticocancellous bone autograft incorporation in the midshaft of the metacarpal on radiographs 3 months after surgery; the single fracture without bone grafting did not unite and required an additional procedure with bone grafting to achieve union. The MCP flexion averaged 81 degrees. All MCP joints attained full extension except for 2 that had a 10 degrees extension lag. One metacarpal required an extensor tendon tenolysis and an MCP capsulotomy. No malrotation of the digits was noted and none of the patients developed an infection. The average shortening was 1.2 mm and 1 metacarpal had an angulation of 6 degrees.

Conclusions: Locked intramedullary nailing of the metacarpal with autogenous iliac crest bone graft is an effective technique for treating low-velocity gunshot metacarpal fractures associated with bone loss and comminution. The locked implant maintains satisfactory alignment, length, and rotation of the metacarpal until graft incorporation and bone healing occurs.