Use of a functional brace for the treatment of a fracture of a
metacarpal caused necrosis of the skin under the dorsal pad in three
patients. In order to evaluate the mechanism of the necrosis, we made in
vivo and in vitro measurements of pressures that are typically found under
the pad. We found that the pressures easily exceeded 260 millimeters of
mercury. Pressures of this magnitude have been shown to cause necrosis of
the skin. Orthopaedic surgeons should be aware of this problem when using
the brace, and perhaps a wider pad should be used to distribute the
force.