Metacarpal and Phalangeal Nonunions

Nonunion of the metacarpals and phalanges are uncommon but can have a devastating effect on hand function when not appropriately treated. Nonunions typically occur due to inadequate reduction and stabilization of the fracture fragments, inadequate blood supply, or infection. Successful treatment of nonunion requires that all these factors are addressed. Fractures that were initially treated with less stable constructs (splinting, K-wires, IM nails) will benefit from more stable fixation (plates, interfragmentary screws, and IM compression screws). Well-vascularized soft tis-sue may be brought in through local flaps or free tissue transfer. Infection should be thoroughly debrided and treated with culture-directed antibi-otics. Bone gaps can be addressed with cancellous autograft, corticocancellous autograft, or vascularized bone grafts. When larger bone gaps are present, the Masquelet technique and vascu-larized bone grafting should be utilized.

Automated summary

Nonunion of the metacarpals and phalanges is rare but can severely impact hand function if not properly treated. Addressing factors such as inadequate reduction and stabilization of fracture fragments, poor blood supply, and infection is crucial for successful treatment. Stable fixation methods, well-vascularized soft tissue transfer, and appropriate management of infection and bone gaps are important considerations.