The management of delayed union and nonunion of the metacarpals and phalanges.

Nonunion and delayed union of the tubular bones of the hand are uncommon occurrences, but are often associated with functional deficits. Twenty-five consecutive phalangeal and metacarpal nonunions and delayed unions in patients seen at the Massachusetts General Hospital were reviewed and classified by the criteria of Weber and Cech. Most of the patients treated had inadequate or improper primary Kirschner wire fixation. Secondary treatment depended upon the associated disability. In seven cases treatment was by bone excision, arthrodesis, or arthroplasty. No treatment was given in four cases. Fourteen patients had operations to gain skeletal union. Rigid skeletal fixation with plates or lag screws was used in seven cases and permitted rapid postoperative mobilization of soft tissue and joint.