Table 2.

Recommended treatment, operative indications, and possible complications for closed metacarpal fracture types

Fracture type	Operative fixation technique	Operative indications	Possible complications
Metacarpal shaft	Long oblique fractures: lag screws Oblique or transverse fractures: plates or IM pinning Multiple fractures: plates	Displaced, irreducible fractures Shortening >6 mm Residual angulation >30–40° in small/ring fingers or >10° in middle or index finger Malrotation Segmental fractures	Pseudoclawing Extension lag Malrotation Stiffness
Metacarpal neck	Intramedullary/Bouquet pinning Transverse pinning Crossed pins	Malrotation Unstable fractures	Loss of knuckle prominence Extension lag Stiffness
Metacarpal head	K-wire fixation Lag screw	Intra-articular fractures with step-off >1 mm, or >25 % articular surface involvement	Joint arthrosis Stiffness