The Use of External Fixator and Iliac Crest Bone Graft in Traumatic Metacarpal Bone Defect

Abstract

Introduction: Metacarpal bone fractures often lead to significant shortening in the phalanges; it can be caused by variable conditions, ranging from idiopathic, and infective to traumatic causes. There are very rare reports of metacarpals shortening in idiopathic primary hypoparathyroidism cases in the literature. Traumatic metacarpal shortening differs from congenital agenesis [2]. This condition leads to both functional and cosmetic limitations which affect the patient's quality of life.

Case report: A 22-year-old male patient was admitted to our outpatient clinic with a traumatic left-hand fracture that caused a bone defect in the second metacarpal shaft leading to bone loss, shortening and flexion limitation in the second finger of the left hand, and a flexion contracture in the first metacarpophalangeal joint. For the treatment plan, an external fixator was set on the second metacarpal of the left hand for a 23 mm elongation over a period of 58 days, elongation rate was organized as 1 mm/day. After achieving the planned elongation, another operation was planned for the reconstruction of the bone defect that has occurred due to trauma in the second metacarpal bone. An osteotomy was performed for extracting an iliac crest graft and inserting it into the bone defect after debridement of scar tissue. For the first metacarpophalangeal joint, an arthrodesis was performed through the use of plate and screws. Multiple studies have showed a common complication of pin tract infections, which were controlled with oral antibiotics and local wound care [10, 11]. Proper alignment and union were achieved with early, stable fracture fixation of low-velocity gunshot wounds of the metacarpal. With early rehabilitation, treatment was provided without an increase in morbidity. [11].

Conclusion: It is possible to obtain acceptable surgical results when the method of fixation of the defect with autograft is used after lengthening with external fixator in pseudoarthrosis with metacarpal defect.

Keywords: Metacarpal fracture; metacarpal defect; metacarpal lengthening/elongation; metacarpal shortening.

Figure 1

Both hands extended long on a surface. Shortening in the second left metacarpal bone was noticed.

Figure 2

Both hands in flexed position on a surface. Limited flexion was noticeable in the left hand.

Figure 3

AP view X-ray of both hands, showing a 2.13 cm bone defect and 2.2 cm shortnening due to bone loss after a war injury in the left second metacarpal bone. Moreover, a flexion contracture in the left first metacarpophalangeal joint. AP view X-ray of the right hand. Showing the normal size of the metacarpal.

Figure 4

Anterior view of the left hand metacarpal external fixator.

Figure 5

Lateral view of the left hand metacarpal external fixator.

Figure 6

Lateral view of the left hand after last surgery.

Figure 7

AP view of the left hand after last surgery.