Metacarpal Neck Fracture Boquet Pinning

This 21-year-old collegiate, soon to turn professional, baseball player sustained a right ring finger metacarpal neck fracture that prevented him from competing in his sport. Based on his chosen profession and his long-term needs, it was felt conservative treatment in a splint or cast would keep him away from baseball too long and might result in painful gripping of the bat once the fracture healed in its angulated position. A minimally invasive surgical technique called “bouquet pinning” was utilized which involved closed reduction of the fracture, elimination of the angulation, followed by manual insertion of precisely bent metal pins (K-wires) across the fracture within the cavity of the bone through a small incision well away from the fracture site. This allowed anatomic fracture reduction and immediate stability. Two weeks following this surgery the player returned to his sport with some protection and restrictions which were lifted over the ensuing 2-3 weeks. He returned to his normal high level of competition and drafted in the second round.