Malunion of a tubular hand bone can result in overlapping of digits when a fist is made and thereby decrease grip strength. One method of correcting a rotatory deformity and scissoring of the fingers can be achieved by a derivational osteotomy of the metacarpal, proximal to the mal-union. The reason for doing this at the metacarpal level as opposed to going back to the primary fracture site is 1) it is easier to perform and 2) patients generally have a better recovery following rigid fixation at the metacarpal level than at a phalangeal level.
Obvious overlapping (scissoring) of the ring finger over the little finger while making a fist. Resulting from a mal-union of a proximal phalanx fracture of the same finger.
Old fracture evident at the neck of the proximal phalanx, ring finger.
Lateral x-ray showing the osteotomy at the mid-shaft of the metacarpal. The distal bone was rotated to correct the overlapping of digits. The new position was rigidly fixated with a low profile titanium plate.
Post-operative extension, lateral view
Post-operative flexion, lateral view
Post-operative extension, dorsal view
Post-operative flexion, palmar view. note that the scissoring has been corrected and no overlapping of the digits is noticed at this time.