Nonunion of metacarpal extraarticular fractures in children: Report of two cases and review of the literature

Extraarticular metacarpal fractures are common during childhood, and osseous healing is the rule. We have treated two patients with delayed and nonunion of three metacarpal shafts. One patient sustained closed second and third metacarpal fractures, and the other sustained an open second metacarpal fracture. Both injuries were crush-type of significant force. Although initial treatment seemed appropriate, delayed union was not appreciated. The children were referred for cosmetic deformity. One of our patients required open reduction/internal fixation with bone grafting, whereas the other was observed. All metacarpal fractures healed. Thorough clinical examination, radiographic views, reduction, and proper immobilization are factors that may help prevent this previously unreported complication in children.