Metacarpal fractures are some of the most common hand injuries encountered in plastic surgery — and knowing when to treat conservatively versus when to operate is critical. In this episode, we review evidence-based management of metacarpal fractures, focusing on nonoperative thresholds, fixation techniques, and practical surgical pearls.

Key topics include:

• Nonoperative care: Angulation tolerances by digit, when splinting is enough, and why rotational deformity is never acceptable.

• Operative indications: Shortening >5 mm, articular step-off >1 mm, or >25% articular involvement .

• Fixation techniques: Percutaneous K-wires, plates, lag screws, intramedullary fixation, and external fixation — with pros/cons for each .

• Thumb metacarpal base fractures: Why Bennett and Rolando fractures demand surgical attention.

• Comparative studies: Evidence suggesting intramedullary pinning may offer superior outcomes for fifth metacarpal neck fractures .

  
  

By the end of this episode, you’ll have a framework for approaching metacarpal fractures in both hand call and exam scenarios.

References:

Wong VW, Higgins JP. Evidence-Based Medicine: Management of Metacarpal Fractures. Plast Reconstr Surg. 2017;140(1):140e–151e. doi:10.1097/PRS.0000000000003470