Necrosis of the skin over the metacarpal as a result of functional fracture-bracing. A report of three cases.
Use of a functional brace for the treatment of a fracture of a metacarpal caused necrosis of the skin under the dorsal pad in three patients. In order to evaluate the mechanism of the necrosis, we made in vivo and in vitro measurements of pressures that are typically found under the pad. We found that the pressures easily exceeded 260 millimeters of mercury. Pressures of this magnitude have been shown to cause necrosis of the skin. Orthopaedic surgeons should be aware of this problem when using the brace, and perhaps a wider pad should be used to distribute the force.
Geiger
K R
KR
Department of Orthopedics, Maricopa Medical Center, Phoenix, Arizona 85008.
Karpman
R R
RR
D000328:Adult; D001696:Biomechanical Phenomena; D001915:Braces / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008663:Metacarpus / Q000293:injuries*; D009336:Necrosis; D011312:Pressure; D012867:Skin / Q000473:pathology*