• M C Müller, K Welle, M Windemuth, C Burger, and P H Pennekamp.
• Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn.
• Z Orthop Unfall. 2013 Oct 1;151(5):525-31.

AimThe goal in treatment of metacarpal fractures is to restore the normal function of the hand. Although a majority of these fractures can be treated non-operatively, surgery is recommended for displaced fractures and in case of a patient wish for primary stability for practise. A poor clinical outcome is described for metacarpal shortening of more than 5 millimeters and for rotational deformity. Whereas plate osteosynthesis may lead to soft tissue irritation involving tendon adhesions and scar formation, we have used the elastic stable intramedullary nailing [ESIN] technique using titanium elastic nails (TEN) for intramedullary splinting of short metacarpal shaft and neck fractures.MethodWithin 5 years, ESIN was performed in 95 patients. The operative technique was evaluated retrospectively concerning its functional results and complications.ResultsSixty-three patients were analysed after an average follow-up of 14.0 ± 5.2 weeks. The mean DASH-Score was 2.3 ± 3.9 points. We saw one implant out-of-position and three cases of skin irritation affording TEN shortening. Two superficial wound infections were treated conservatively. Pseudarthrosis and nail breakage were not observed. After TEN removal 9 ± 2.4 weeks post implantationem no refracture occurred.ConclusionMinimally invasive intramedullary stabilisation of short metacarpal shaft and neck fractures with a TEN is a safe surgical technique and achieves primary stability for practise. It reliably leads to fracture healing and produces excellent functional results.Georg Thieme Verlag KG Stuttgart · New York.

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