Antibiotic-Loaded Calcium Sulfate as an Adjunct in the Acute Management of a Traumatic Segmental First Metacarpal Defect.

Traumatic segmental bone defects of the hand are uncommon injuries that may require complex reconstruction to restore skeletal stability and function. Calcium sulfate is widely used as a biodegradable bone void filler and local antibiotic carrier, although its use during the acute management of traumatic metacarpal defects has been rarely reported. We present the case of a 55-year-old man who sustained a severe open injury to his dominant hand caused by a radial saw, resulting in dissociation of the first and second rays, segmental bone loss involving approximately 40% of the first metacarpal (approximately 20 mm), and a subcapital fracture of the second metacarpal. Complete laceration of the extensor pollicis longus and flexor pollicis longus tendons was also identified. Following meticulous debridement, microsurgical repair of the deep branch of the palmar arch was performed. The second metacarpal was stabilised with a cannulated screw, while the first metacarpal was stabilised with two Kirschner wires and the osseous defect was filled with gentamicin-loaded calcium sulfate. The injured tendons were subsequently repaired. Complete radiographic union was achieved at three months. At eight months, tip pinch strength was 7 kg and grip strength was 16.2 kg, corresponding to 32% and 45% of the contralateral hand, respectively. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 34. Despite these residual strength deficits, the patient reported satisfaction with the functional outcome and returned to activities of daily living and recreational sports. In this patient, antibiotic-loaded calcium sulfate was used as an adjunctive bone void filler and local antibiotic carrier in the acute setting, when immediate definitive bone reconstruction was not feasible. Further studies are required to determine whether similar outcomes can be reproduced in traumatic metacarpal defects.