Cellular Bone Matrix for the Treatment of Considerable Bone Loss in Two Metacarpal Fractures.

High-energy mechanisms that lead to hand fractures can create substantial bony defects that are not amenable to traditional treatments. Management options include autograft, allograft, and bone graft substitutes such as calcium sulfate/phosphate cements, which provide good results when used appropriately however each strategy has limitations. Cellular bone matrices (CBMs) are newer graft substitutes designed to supply osteogenic cells along with scaffold and inductive factors. We present a case series of metacarpal fractures with considerable ballistic-related defects treated with CBM augmentation. Two male patients (mean age 32 years) sustained second metacarpal fractures from high-caliber ballistic injury and were followed for 19 months. One required later tenolysis and dorsal capsulotomy for stiffness. Both demonstrated full radiographic union and CBM incorporation on computed tomography. This series shows excellent radiographic outcomes using CBM for metacarpal defects. Although further study is needed, to our knowledge, this is the first published evidence supporting CBM as an effective option for these injuries.