Metacarpal Titanium Elastic Nail insertion

UK) fixation requires a 2.5mm drilled entry point at the base of the metacarpal. This can damage soft tissues including the extensor tendon and also risks breaching the volar cortex. We recommend opening the dorsal metacarpal cortex with a curved artery clip (Fig 1). Initially, Figure 2 Clip turned 180° to continue along medullary canal Figure 1 Entry point gained using clip to penetrate the near cortex Figure 1 The Tuohy needle and Ethilon ® suture have been passed through the labrum. The Mitek ® anchor is in place. Figure 2 The small anterior scar visible at two weeks graspers can be inserted through the 6mm cannula to aid manipulation of the labrum or the Tuohy needle. A size 0 Ethilon ® suture (Ethicon, Somerville, NJ, US) is advanced through the needle and across the face of the glenoid as a shuttle suture (Fig 1), and the labral repair is undertaken in the normal way. DISCUSSION This technique uses readily available equipment and allows access to the inferior labrum as a Tuohy needle is sufficiently slim to pass through the superior part of the subscapularis. Furthermore, it leaves the patient with only one small anterior scar (Fig 2). Figure 3 Titanium Elastic Nails, showing the curved profile point the tip downwards to penetrate the cortex, turning the clip 180° to advance it down the medullary canal (Fig 2). The curve on the clip mimics the profile of a 2.0mm TEN (Fig 3) and its natural entry to the metacarpal. The less traumatic nature of this approach may lead to improved soft tissue protection.