gms | German Medical Science

Objectives/Interrogation: Fractures of the Metacarpophalangeal joints (MCP) are relatively common but frustrating fractures to address surgically. This can include Thumb bony skier's thumb injuries, diepunch fractures of the proximal phalanx bases, or articular dome fractures of the metacarpal head amongst others. Lesser fractures, including ones with small fragments, are often treated conservatively with unpredictable clinical results, while more severe fractures are addressed via extensile open approaches where the treatment may be as deleterious as the fracture itself.

Methods: ARIF (arthroscopic assisted reduction/internal fixation) utilizes a minimally invasive approach via a 1.9 scope (Nexus Salt Lake City, UT) where visualization of the fracture site is superior to open means, associated soft tissue lesions and synovitis can be addressed, and anatomic reduction is superior due to direct observation of the articular surface at time of stabilization. Applying internal fixation via percutaneous technique, with arthroscopic visualization, also avoids the consequent stiffness that invariably results from violating the joint capsule/Sagittal hood in open surgery.

5 representative clinical cases will be presented to outline the basic principles of this methodology designed to leverage newer small joint technologies to encourage superior clinical outcomes.

Results and Conclusions: Arthroscopic reduction followed by internal fixation is a superior method for obtaining an anatomic reduction of a critical joint surface for hand function.

Arthroscopy provides superior visualization, allows concomitant soft tissue injury management, synovectomy and better confirms the quality and accuracy of the articular reduction.

Surgeons should begin to train in small joint arthroscopy methods in order to provide patients with the best option for these challenging fractures of the MCP.