Introduction: Intramedullary fixation is a recognised method of fracture fixation in fifth metacarpal fractures. We describe a new technique for fixation of fractures of the middle three metacarpals.

Patients and Methods: We reviewed a single surgeon’s series of 16 male patients (mean age 27.9 years, range 18–46) with 20 displaced transverse midshaft fractures of the 2nd, 3rd and 4th metacarpals treated by antegrade intramedullary Kirschner wiring. Work related and domestic accidents constituted the mode of injury in 8 patients and in the remaining 8 as a result of an assault, fall or road traffic accident. Twelve patients were in employment at the time of injury including four heavy manual labourers.

A single pre-bent 1.6 millimetre Kirschner wire was inserted into the medullary canal through a drill hole in the metacarpal base and passed across the reduced fracture into the metacarpal head. The proximal end of the wire remained protruding percutaneously. Following stabilisation of the fracture, early mobilisation was commenced.

Results: All of the study group had satisfactory clinical and radiological outcomes. All of the fractures united clinically and radiologically. There was one case of delayed union, with union at 35 weeks. In the remaining patients fracture union had occurred radiologically at an average of 5.4 weeks (range 4–12 weeks). Radiologically there was a mean angular deformity of 4.05° (range 0–11°) in the coronal plane and 0.75° (range 0–9°) in the sagittal plane. Postoperatively 2 patients developed a pin tract infection requiring treatment with antibiotics and early removal of the K-wire. All patients on questioning by telephone questionnaire were satisfied with their resulting hand function and appearance. All patients had returned to normal activities of daily living by 8 weeks. Of those patients in employment all had returned to work by 6 weeks (mean 3.3. weeks).

Conclusion: Antegrade intramedullary single K wiring is a useful technique for managing unstable midshaft metacarpal fractures producing excellent clinical and radiological results.

We performed 20 de la Caffiniere trapeziometacarpal arthroplasties for osteoarthritis occurring only at this joint and reviewed all patients after periods of up to ten years. Eighteen arthroplasties were satisfactory postoperatively, although all 20 patients had a satisfactory range of motion and only one experienced pain after surgery such that it impeded normal function. Failure occurred in two patients and was due to overreaming of the trapezium during surgery and a traumatic dislocation. A radiolucency between the prosthesis and bone was observed in one arthroplasty, although this patient was asymptomatic. We recommend arthroplasty using the de la Caffiniere prosthesis as a satisfactory method of treatment for the osteoarthritic trapeziometacarpal joint.

Augmentation of the acetabular component of total hip replacements is a method of increasing stability and preventing recurrent dislocation. We report a series of mechanical experiments designed to evaluate the turning moments and angles required to dislocate standard, long posterior wall and two different augmented prostheses.