Fracture of the base of the thumb is typically the so called “Boxer's fracture,” which results from striking a solid object
with a clenched fist and the thumb folded into the palm. Metacarpal fractures involve mainly the base of the thumb and the
neck of the fifth and fourth metacarpals [1]. The fracture generally propagates across the growth plate (Salter II fracture).
Displacement occurs in the direction of palmar flexion. Bone remodeling capacity in this region is excellent, and indications
for flexible intramedullary nailing (FIN) are scarce. Angulation of up to 50–60° is acceptable in a child who has at least
3–4 years of growth remaining. Retrograde intramedullary wiring is necessary where severe instability precludes nonoperative
management. Jehanno and Iselin recommend wiring in pure metaphyseal fractures and Salter II fractures with a lateral Thurston-Holland
fragment [2]. The rare intra-articular fractures (Salter III and IV) that are encountered are surgically managed to restore
a perfect articular congruity.
In France, antegrade intramedullary wiring of the first metacarpal has been popularized by Kapandji, who used to insert one
single wire through the trapeziometa-carpal joint. The concept of FIN based on the placement of two contoured wires, which
leave the adjacent joints completely free was described in the literature later on [3]. This technique is particularly well
suited for long bones of the hand [1].