Successful Fixation of Right Metacarpal Head Fracture in a 26-Y.O Female with Closed Reduction and TENS Nail
PACE Hospitals’ expert Orthopaedic team successfully performed a
Closed Reduction and Titanium Elastic Nail System (TENS) Fixation for a fracture of the right 5th metacarpal head in a 26-year-old female patient who presented with pain and difficulty in moving her right hand, following an alleged history of a fall on the stairs. The purpose of the surgery was to realign and stabilize the fractured bone, promote proper healing, restore hand function, and prevent long-term deformity or loss of mobility.
Chief Complaints
A 26-year-old female patient with a
body mass index (BMI) of 22 presented to the Orthopaedics Department at
PACE Hospitals, Hitech City, Hyderabad, with complaints of pain and difficulty moving her right hand, following an alleged history of a fall on the stairs. The patient had no history of loss of consciousness, ear, nose, or throat (ENT) bleeding or vomiting.
Past Medical History
The patient had no known history of drug allergies or chronic illnesses. The absence of comorbid conditions was considered clinically favourable, as it minimised the risk of intraoperative and postoperative complications and supported a smoother, more stable recovery.
On Examination
The patient was conscious, coherent, and oriented, with stable vitals. On general examination, swelling was observed over the right hand, with tenderness noted over the 5th metacarpal head region. Crepitus was palpable, and abnormal mobility was demonstrated at the site of injury. No distal neurovascular deficits were present.
Diagnosis
Following the clinical examination, the orthopaedic team conducted a comprehensive assessment, which included a detailed review of the patient’s medical history and a focused evaluation of the right hand.
To confirm the diagnosis and evaluate the extent of the injury, an X-ray of the right hand in anteroposterior, oblique, and lateral views was performed, which revealed a displaced fracture of the 5th metacarpal head. The imaging helped precisely identify the fracture pattern and displacement, which was crucial for planning appropriate treatment. The absence of distal neurovascular deficits indicated no associated nerve or vascular injury, suggesting that the fracture was isolated and there were no complications affecting circulation or sensation in the hand.
Based on the confirmed diagnosis, she was advised to undergo
Right 5th Metacarpal Head Fracture Treatment in Hyderabad, India, under the care of the Orthopaedic Department, ensuring comprehensive management and optimal recovery.
Medical Decision Making
After a detailed consultation with the senior orthopaedic consultant, Dr. Anand Agroya, a comprehensive evaluation was carried out to determine the most appropriate diagnostic and therapeutic approach for the patient. The orthopaedic team conducted a thorough assessment, including a detailed review of the patient’s history and a focused physical examination of the right hand. Diagnostic imaging with X-rays confirmed a displaced fracture of the right 5th metacarpal head.
It was determined that the patient had a right 5th metacarpal head fracture, which was causing pain and difficulty in moving her hand. Closed Reduction and TENS Nail Fixation was identified as the most effective intervention to realign and stabilize the fracture, promote healing, and restore hand function.
The patient and her family were thoroughly counselled regarding the severity of the injury, the planned surgical fixation, the potential risks involved, and the necessity of the procedure for restoring hand function and promoting proper healing.
Surgical Procedure
Following the decision, the patient was scheduled to undergo Closed Reduction and TENS Nail Fixation surgery in Hyderabad at PACE Hospitals, under the supervision of the expert Orthopaedic Department.
The following steps were carried out during the procedure:
- Administration of Anesthesia: The patient was administered regional block anesthesia to ensure adequate pain control and immobility of the right hand throughout the procedure.
- Preparation and Positioning: The patient’s right hand was sterilized and draped in a sterile manner. The hand was positioned to provide optimal access to the 5th metacarpal head for the surgical team.
- Closed Reduction: Using fluoroscopic guidance (C-arm), the surgeon performed a closed reduction by manipulating the fractured bone fragments externally to realign them into their proper anatomical position without making an incision.
- TENS Nail Fixation: Once proper alignment was confirmed on imaging, a small incision was made, and a Titanium Elastic Nailing System (TENS) nail was inserted into the medullary canal of the 5th metacarpal to stabilize the fracture internally.
- Wound Closure and Dressing: The incision site was closed with sutures, and a sterile dressing was applied. The hand was then immobilized with a wrist and forearm support splint to protect the fixation and aid in healing.
Postoperative Care
The postoperative period was uneventful. Postoperatively, the patient was monitored in the recovery ward for a few hours. On postoperative day 1, the dressing was changed. During her hospital stay, she received intravenous antibiotics, analgesics, and supportive care. The patient was discharged in a hemodynamically stable condition with prescribed medications and instructions for home care and follow-up.
Discharge Medications
The patient was prescribed a course of antibiotics to prevent postoperative infection, anti-inflammatory medications to reduce pain and swelling at the fracture site, and a proton pump inhibitor to protect the stomach lining from irritation caused by the anti-inflammatory drugs. These medications were given as part of the standard post-surgical care to support healing and ensure patient comfort.
Advice on Discharge
The patient was advised to continue using a wrist and forearm support splint and to maintain limb elevation to reduce swelling and promote healing.
Emergency Care
The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, abdominal pain, and vomiting.
Review and Follow-up Notes
The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after 3 days for further evaluation.
Conclusion
This case highlights the successful management of a displaced right 5th metacarpal head fracture through Closed Reduction and TENS Nail Fixation. The patient had an uneventful postoperative recovery and was discharged in stable condition. Proper follow-up and adherence to post-operative care were advised to ensure complete functional recovery.
Optimizing Hand Function Recovery Through Closed Reduction and TENS Nail Fixation in Metacarpal Fractures
This case demonstrates the significance of precise and minimally invasive surgical intervention in managing displaced 5th metacarpal head fractures to restore hand strength and mobility. By employing closed reduction and TENS nail fixation, the
Orthopaedic doctor / Orthopaedic surgeon achieved accurate fracture alignment and stable internal fixation, minimizing soft tissue trauma and preserving neurovascular integrity. The surgeon’s expertise was instrumental in ensuring optimal positioning and fixation, which facilitated early rehabilitation and accelerated healing. This approach reflects advancements in orthopaedic trauma care, focusing on effective surgical techniques combined with comprehensive postoperative management to maximize functional recovery and patient quality of life.
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