Certain technical demands must be overcome in order to accomplish the goals of creating a functional hand when performing a central digital ray resection of the hand. One of the biggest challenges is maintaining metacarpal gap closure and in such a way that the metacarpals are balanced and not rotated. Inadequate closure of the defect created between the metacarpals by a central ray resection will produce a persistent gap between the remaining fingers as well as the potential for malalignment. Current techniques are fraught with difficulty and have frequently proven inadequate. We describe a technique for performing a central ray resection without the worry of nonunion, malunion, or increase in gap. With the development of newer fixation devices, we have been able to perform central ray resection while optimally closing the gap, controlling rotation, and providing good hand function.
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