Intra-medullary Cannulated Headless Compression Screw for Bone Graft Fixation in Metacarpal Fractures.

High energy metacarpal fracture presenting with critical bone loss requires bone graft and hardware stabilisation. Early bone grafting and rigid internal fixation allow expedited patient recovery. Plate fixation is the most described technique when an autologous bone graft is being used. In this report, we present an alternative technique to secure bone grafts to metacarpal shafts with intra-medullary headless compression screws (HCS). In the presented patient, significant bone defects of the fourth and fifth metacarpals were bridged using iliac crest cortico-cancellous bone grafts and fixed with HCS. This method of fixation allowed controlled early active mobilisation. Bone graft incorporation and excellent active range of motion were demonstrated. Level of Evidence: Level V (Therapeutic).

PBNR: Percutaneous Blunt Needle Reduction of Bony Mallet Injuries.

Mallet finger injuries are common; treatment goals include achieving joint stability, preventing extensor lag, and subsequent swan-neck deformity. We describe a simple technique for improving intraoperative bony mallet reduction, which may avoid the requirement for closed Ishiguro extension blocking wires or open fixation, and present a prospective case series (n=12). Intraoperative percutaneous blunt needle reduction (PBNR) is achieved under image intensifier guidance. Using artery forceps, a blunt fill needle tip is manipulated onto the proximal avulsed fragment; this is then guided into a reduced position and maintained using a well-formed Zimmer splint across the distal interphalangeal joint in 15- to 30-degree extension. There were 5 injuries involving >1/3 of the articular surface (Doyle's classification IVb) and 7 injuries involving >1/2 of the articular surface (Doyle's classification IVc). Mean hand therapy follow-up was 10.6±1.0 weeks, extensor lag was 4.6±1.7 degrees, and all patients achieved full functional recovery with return to normal daily activity. No complications were reported. Closed techniques, for example, Ishiguro extension blocking wires, may reduce the risks associated with open reduction, but do not avoid further articular surface damage. PBNR offers the surgeon a useful adjunct to the treatment options for bony mallet injuries, without excluding progression to surgical fixation if required. PBNR represents a less-invasive management option for bony mallet injures where surgical fixation may also be indicated.