Learning Objectives: After studying this article, the participant should be able to: 1. Understand the indications for metacarpal fixation. 2. Understand the rationale for various surgical treatment options, based on high-level evidence where available. 3. Describe selected operative techniques and their postoperative management. Background: Metacarpal fractures are extremely common, constituting one in five fractures that present to the emergency department. Although many metacarpal fractures can be treated nonoperatively, some require surgery. The purpose of this CME article is to present a practical, up-to-date guide to the management of these common injuries. Methods: A review of nonoperative management, surgical indications, and selected surgical techniques is provided. The authors reviewed the literature related to the treatment of metacarpal fractures, and the highest level evidence available to help guide decision-making is presented. Conclusions: Metacarpal fractures can often be treated nonoperatively, although some fractures will benefit from surgical treatment. Although there is some high-level evidence to guide decision-making, there are many clinical scenarios for which there is little high-quality applicable research. As a general principle, the treatment option that achieves the desired reduction and degree of fixation, allows early motion, and minimizes soft-tissue injury should be preferred.
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