Metacarpal neck closed reduction and pinning

Table: almost every procedure can be done on the pre-op stretcher with a hand table attached.

Cautery: bipolar electrocautery for every case.

Tourniquet: local or MAC cases often use an Esmarch tourniquet, or a Tourni-cot for a finger. Cases under a nerve block use an 18" arm tourniquet.

Standard local: 10 mL total, 50/50 mix of 1% lidocaine with epinephrine and 0.25% bupivacaine (Marcaine) with epinephrine. Use local without epinephrine if the patient has a history of Raynaud's, and for the finger fracture and fusion cases marked "without epinephrine".

Base dressing on every wound: Adaptic, wet 4x4, dry 4x4, then the case-specific outer wrap or splint on the card.

Have available: hand tray, tourniquet, bipolar; Coban, Tegaderm, ACE wrap, Steri-Strips, benzoin or Mastisol; sutures 4-0 nylon, 4-0 Vicryl, 4-0 Monocryl, 3-0 Vicryl, 3-0 Monocryl.

Post-op appointments: most first post-op visits are at 2 weeks unless the card or the booking says otherwise. Book the first hand therapy visit at the same time as the post-op surgeon or PA visit.

Abbreviations: CRPP = closed reduction percutaneous pinning; ORPP = open reduction percutaneous pinning; ORIF = open reduction internal fixation; MAC = monitored anesthesia care; WALANT = wide-awake local anesthesia, no tourniquet.