General principles of fracture reduction involve axially distracting or pulling on a fracture fragment and pushing the piece back into anatomical alignment. This can be seen in the video above (automatically starts at 2:25 for the actual procedure). What if this approach doesn't work? The fracture fragment remains immobile despite your best efforts.
Trick of the Trade:
Jahss reduction technique
This technique, also known as the 90-90 approach, involves flexing the patient's MCP and PIP 90 degrees. Dorsal force is applied to metacarpal head by through dorsal pressure on the proximal phalanx. The 90-90 positioning also stretches the collateral ligaments of the MCP joint, which further optimizes the reduction technique.
Although this cool animation below was intended for patient education, it nicely illustrates how the Jahss technique works.
See the Paucis Verbis card on Metacarpal Fractures .