Metacarpal nonunion is a rare outcome of metacarpal injury, and little has been published
about its management. Care typically includes open reduction and internal fixation
with a possible bone graft, similar to the treatment of other nonunions. However,
there is no literature guidance if traditional methods do not lead to union. To improve
the treatment of these recalcitrant metacarpal diaphyseal nonunions, we proposed a
new surgical technique using a “top hat” bone graft harvested from the iliac crest.
The graft is carefully shaped to create a cancellous “crown,” which is inserted into
the nonunion site, and cortical “brims,” which are used to secure the graft to the
metacarpal. This has been successful in treating 2 cases of metacarpal nonunion that
failed to heal with first-line intervention.
Key words
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References
- Treatment of nonunion and malunion following hand fractures.Clin Plast Surg. 2011; 38: 683-695
- Scaphoid fractures: nonunion and malunion.J Hand Surg Am. 2016; 41: 1087-1092
- Treatment of scaphoid nonunion: a systematic review of the existing evidence.J Hand Surg Am. 2015; 40: 1797-1805.e3
- The management of delayed union and nonunion of the metacarpals and phalanges.J Hand Surg Am. 1985; 10: 457-466
- Bone-graft harvesting from iliac and fibular donor sites: techniques and complications.J Am Acad Orthop Surg. 2001; 9: 210-218
Article info
Publication history
Published online: May 18, 2022
Accepted:
March 27,
2022
Received:
February 25,
2022
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
