Metacarpal CRPP - Tips please

[Orange Julius]

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Maybe it's just me but I find pinning fractures to be one of the hardest skills to master. It's odd because it looks like the easiest thing in the world to do.

I was hopeless at first but I'm actually getting pretty decent at it. I'm stuck on one thing though and I can't seem to make a breakthrough. It's recess pinning of a metacarpal fracture. Where you place a pin from the collateral recess down the medullary canal, across the fracture and into cortical bone.

It's hard to get the pin to bite without slipping off and skiving outside the bone. I have to start with a steeper angle and move quickly parallel to the axis to get the pin down the canal.

My success rate is about 50/50. And it sometimes takes a while.

I can't seem to work out exactly what it is that works, when it works.

What is the key here? Is there a particular magic starting angle? Starting point? Any ideas would be appreciated.

 

[Buckeye(OH)]

You can try on oscillate, that often prevents the sciving ( I dont know how to spell that). Additionally like you said, start at a steeper angle then back it out once you have a hole. If you don't back it out, you are just bending the pin. One of the hand attendings at cincy childrens said to back it out at the angle you intend to go in...when you see the pin straighten out, then run it in forward.