Management of infected defect nonunion of the metacarpals.

A 30-year-old man sustained a displaced closed fracture of the fourth metacarpal bone, which was treated by open reduction and internal fixation with Kirschner wires. Severe postoperative infection led to a segmental defect with shortening of the fourth metacarpal bone and infected defect nonunion of the fifth metacarpal bone. After serial debridements and intravenous antibiotics, the infection was controlled. An AO external minifixator was applied to restore the length of the fourth metacarpal bone and to stabilize the fourth and fifth metacarpals, and iliac bone grafting was performed, leading to complete healing and restoration of normal hand function.