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Bhandari et al. Plast Aesthet Res 2017;4:174-7 Plastic and
DOI: 10.20517/2347-9264.2017.65
Aesthetic Research

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Original Article Open Access

Degree and location of metacarpal angulations

Laxminarayan Bhandari, Cynthia Sathekga, Francisco Aguilar, Luis Vicentela, Elkin Galvis
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY 40202, USA.

Correspondence to: Dr. Laxminarayan Bhandari, Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850,
Louisville, KY 40202, USA. E-mail: lbhandari@cmki.org
How to cite this article: Bhandari L, Sathekga C, Aguilar F, Vicentela L, Galvis E. Degree and location of metacarpal angulations. Plast Aesthet Res
2017;4:174-7.

ABSTRACT
Article history: Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate
Received: 9 Sep 2017 fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals
Accepted: 21 Sep 2017 with plates and screws, plates are bent to contour the dorsal surface. However, there are no
Published: 20 Oct 2017 reference values in literature for the location and degree of angulation. The authors studied the
dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of
Key words: angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30
Metacarpals, hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy.
plate fixation, These pictures were analyzed using Image J software. The dorsal cortex angle was measured
anatomy in each image, and the center of rotation of angulation (CORA) was identified. The distance
from the CORA to the base of metacarpal was measured and calculated as a percentage of
the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The
average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°;
SD, 4.73), 3rd = 10° (range, 1-25°; SD, 5.28), 4th = 11° (range, 1-20°; SD, 4.45), 5th = 12°
(range, 2-24°; SD, 5.11). The average location of the CORA from the base of the metacarpal
as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger,
52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion:
These measurements are able to serve as reference values for plate bending while operating on
a metacarpal fracture or metacarpal corrective osteotomy.

INTRODUCTION During plate fixation, it is a common practice to
[3]
bend the plates . If the plate is not adequately bent,
Metacarpal fractures are a common injury of the hand, tightening the screws will result in a gap in the opposite
with an incidence of 13.6/100,000 in the United States cortex [Figure 1]. The location and degree of plate
[1]
each year . The angulation and displacement are bending can be challenging to predict, especially in
crucial factors in determining operative management. cases of a comminuted fracture, or fracture with bone
There are various options for fixation of metacarpal loss. Therefore, a thorough knowledge of the anatomy
fractures which include K wires, intramedullary nails, of the dorsal surface is important. However, literature
plates and screws, and external fixators. Plate and is scarce with this regard. The various metacarpal
screw fixation is commonly employed for complex parameters described in literature include capital and
injuries . subcapital angulations, proximal articular inclination,
[2]
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