Background
Several methods of fixing unstable metacarpal shaft fractures have been described; the aim of the study was to assess the clinical and radiological results of bouquet technique in management of unstable metacarpals fractures.
Patients and Methods
` A prospective study held between 2017 and 2019 at Benha University Hospital on 20 patients (15 males and 5 females) had unstable metacarpal fractures affecting second to fifth metacarpals treated with bouquet technique. The patient’s mean age was 31.6 years. The dominant hand was affected in 15 patients while in 5 patients the non-dominant hand was affected. Under fluoroscopy, closed reduction and percutaneous bouquet pinning fixation was done using two or three K-wires. The mean operative time was 26.5 minutes. The inclusion criteria included patients with acute metacarpal shaft fracture with unaccepted shortening, angulation and rotation.

Results
The mean follow-up period was 11.6 weeks. Bony union achieved at an average of 7.4 weeks. At the final follow-up, all patients had almost full ROM with a mean total active range of motion 260.5° (245°- 270°). None of the patients had any clinically detectable rotational deformity, functional outcome was satisfactory with mean grip strength of the injured hand 96% in comparison to the non-injured side, average Quick Dash score was 1.45 (± 1.2) ranging from zero to 4 points. The mean VAS for pain was 0.85 (± 0.8). All patients returned to their ordinary jobs and were cosmetically and functionally satisfied with the results of their surgery. One patient presented with stiffness and improved gradually with physiotherapy.one patient united with 10º angulation of the 5th metacarpal without any functional affection or extension lag. No other complications reported.

Conclusion
Bouquet technique is an effective, easy and safe method for treating unstable metacarpal fractures, without significant complications.