SUBMIT study: metacarpal fracture fixation

INTERVENTION: Participants are randomly allocated to one of two groups, who will receive a different type of open reduction internal fixation (ORIF) surgery. Group 1: Participants undergo bicortical fixation (standard practice), in which both the dorsal and palmar cortices of the metacarpal are drilled though Group 2: Participants undergo unicortical fixation, in which only the near cortex is drilled Participants in both groups are followed up for 6 months to monitor recovery. CONDITION: Topic: Surgery; Subtopic: Surgery; Disease: All Surgery ; Musculoskeletal Diseases ; Metacarpal fractures PRIMARY OUTCOME: Fracture union is assessed at 6 weeks and 6 months SECONDARY OUTCOME: 1. Complication rate is monitored continually throughout study; 2. Fluroscopy exposure is measured during surgery; 3. Implant failure is measured at 6 weeks and 6 months; 4. Post operative stiffness is measured at 6 weeks and 6 months; 5. Surgical time is measured during surgery INCLUSION CRITERIA: 1. Aged 18 or over 2. Metacarpal diaphyseal fractures that require plate fixation 3. Patients undergoing anaesthesia with axillary brachial plexus regional blocks 4. Acute injury (within 72 hours)