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performing this technique, the surgeon should be careful not to laterally translate the metacarpal head. Numerous other techniques for pinning have been advocated (Table 41-1).

Rarely, open reduction through a dorsal extensor splitting approach is necessary. Although pin fixation as described previously can be employed for fixation, a dorsal tension band wire loop also works well and avoids the potential problems associated with exposed pins. Alternatively, some authors advocate the use of a laterally placed minicondylar plate.

After any surgical stabilization, a Pl-blocking plaster or Orthoplast splint is employed to protect the fixation. Active PIP and distal interphalangeal (DIP) range-of-motion exercises of the injured finger to full composite flexion of adjacent digits are begun immediately postoperatively. Residual MP stiffness is treated with active, passive, and dynamic modalities 6 weeks after surgery.

Delayed presentation of an open boxer's fracture is a contraindication to internal fixation. All wounds over a metacarpal neck fracture should be considered a human bite until proven otherwise. If the status of the wound is questionable, delay fixation until the soft tissue envelope has healed.

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