This 2000 JAAOS review by Kozin et al. addresses operative management of diaphyseal fractures of the metacarpals and phalanges — covering anatomy, fracture mechanics, implant biomechanics, fixation techniques, reported outcomes, and complications. The central question: when do these fractures need surgery, and how should fixation be chosen?
When evaluating a metacarpal or phalangeal shaft fracture, digit-specific angulation thresholds and rotational alignment in flexion drive your operative decision — a small-finger metacarpal tolerating 50° that would mandate fixation in the index finger.
When operating, match implant to fracture geometry: lag screws alone for long oblique fractures (>2× bone diameter), add a neutralization plate for shorter ones, and always confirm rotation with the patient making a fist before closing.
This 2000 JAAOS review by Kozin et al. addresses operative management of diaphyseal fractures of the metacarpals and phalanges — covering anatomy, fracture mechanics, implant biomechanics, fixation techniques, reported outcomes, and complications. The central question: when do these fractures need surgery, and how should fixation be chosen?
When evaluating a metacarpal or phalangeal shaft fracture, digit-specific angulation thresholds and rotational alignment in flexion drive your operative decision — a small-finger metacarpal tolerating 50° that would mandate fixation in the index finger.
When operating, match implant to fracture geometry: lag screws alone for long oblique fractures (>2× bone diameter), add a neutralization plate for shorter ones, and always confirm rotation with the patient making a fist before closing.