From the Research
The primary treatment for nonunion of a metacarpal fracture is surgical intervention, typically involving open reduction and internal fixation (ORIF) with bone grafting, as it provides the best chance for fracture union and restoration of hand function. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of early mobilization and stable fixation in achieving optimal outcomes for metacarpal fractures 1.
Key Considerations for Treatment
- The goal of surgical intervention is to stabilize the fracture site, promote bone healing, and restore hand function.
- The procedure usually involves removing fibrous tissue at the nonunion site, placing bone graft material, and securing the fracture with hardware such as plates, screws, or K-wires.
- Postoperatively, patients require immobilization for 2-6 weeks depending on fixation stability, followed by progressive hand therapy to restore motion and strength.
- Supplementary treatments may include low-intensity pulsed ultrasound or bone stimulators in select cases.
Rationale for Surgical Intervention
Surgery is necessary because metacarpal nonunions rarely heal with conservative management alone due to the hand's complex biomechanics and the constant forces applied to these bones during daily activities. Risk factors that may have contributed to the nonunion, such as infection, inadequate initial immobilization, poor blood supply, smoking, diabetes, or malnutrition, should be addressed concurrently to optimize surgical outcomes. While other studies have explored alternative fixation methods, such as headless compression screws 2 and mini-plate fixation 3, the principle of achieving stable fixation to promote healing remains consistent.
Addressing Potential Complications
It's also important to consider the potential complications associated with surgical intervention, including hardware failure or the need for additional surgeries. However, the benefits of surgical treatment in achieving fracture union and restoring hand function outweigh these risks, especially when considering the long-term morbidity and impact on quality of life associated with nonunion of a metacarpal fracture. Other treatments, like teriparatide for nonoperative management of fracture nonunion 4, may have a role in specific cases but are not the primary treatment for metacarpal nonunion. Older studies discussing resorbable plate fixation 5 highlight the evolution of surgical techniques and materials but do not alter the fundamental approach to treating metacarpal nonunion.