Modified Step-Cut Osteotomy for Metacarpal and Phalangeal Rotational Deformity

PurposeRotational deformity of metacarpal and phalangeal fractures can jeopardize normal hand function and cause aesthetic problems for patients. We have found the Z-cut metacarpal osteotomy, initially described by Manktelow, to prove predictable and provide precise restoration of rotation and function. Therefore, we reviewed our experience with this technique.MethodsThe senior authors identified 12 patients treated with rotational step-cut osteotomies for digital rotatory deformities. The cases were reviewed retrospectively. Seven had metacarpal and five had phalangeal malunions.ResultsAll 12 patients had correction of their deformities, obtained union of the osteotomy, and maintained or improved their motion. There were no perioperative complications.ConclusionsMetacarpal step-cut osteotomies are a technically simple and effective method for correction of digital rotational deformities resulting from fracture malunions. Unlike other types of osteotomies, this technique affords precise intraoperative control at the osteotomy site, a large surface area for bony healing, and rigid fixation with early digital motion.