Case history, clinical findings: Forty-one-years old male patient suffered a multiple comminuted closed metacarpal (mtc) fracture of the dominant hand, sustained by the preasure machine. Shortening of the metacarpus was clinically obvious, with high local swelling and correct neurovascular status.

Diagnosis: Comminuted fractures of II-V mtc was confirmed by x-ray and CT.

Therapy and Progressions: The decision was to mantaining normal length of the fractured mtc bones with as more less surgical incisions – by external fixation. There was available only one mini-external fixator at the moment. Temporary fixation of K-wires during the surgery was performed by the frame of Mitkovic-type external fixator, first on IV, and after on III mtc bone. During such temporary fixation, followed by fluoroscopy checks, K-wires were connected by the bone cement for each of these mtc bones. Afterwards, mtc II fracture was fixed by the external fixator frame used. The fracture of mtc V bone was fixed by free K-wires.

Results: Activities such as pen writing or full glass holding were feasible even 4 days after surgery. Full removal of the implants was performed at the outpatient clinic 8 weeks after surgery and the physical therapy was sterted soon.

Comments: Multiple mtc fractures can be succesfully treated by external fixation. Mitkovic-type external fixator could be used both as an aid-device during the surgery, and as an definitive fixation method.

References:

Milenkovic SS, Mitkovic MM, Mitkovic MB, Bumbasirevic MZ, Bumbasirevic VM. Unilateral 3D external fixation in Serbian traumatology and orthopaedics. Int J Clin Pract. 2021; 75(9):e14411.Mitkovic MB, Bumbasirevic MZ, Lesic A, Mitkovic MM, Mitkovic MM, Jakovljevic A. Deformities correction of metacarpal and phalangeal bones by the use of Mitkovic minifixator. Acta Chir Iugosl. 2010; 57(4):99-101.Hadeed A, Werntz RL, Varacallo M. External Fixation Principles and Overview. Treasure Island (FL): StatPearls Publishing. 2024.

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