Leslie Sisco-Wise, MD – Section Head of Hand Surgery, Director of Hand Surgery Clinic Ochsner Baptist Medical Center New Orleans, LA. Case Presentation: The patient was a 30-year-old male who sustained a crush injury to his hand from a trailer. He presented to clinic with midshaft, oblique fractures with comminution to his third and fourth metacarpals and a comminuted fracture of his second metacarpal head. This complex fracture case also included midshaft to base, oblique fractures with comminution to his third and fourth proximal phalanges. As a manual laborer, the patient wanted a minimally invasive approach that achieved stable fixation for early range of motion (ROM) so that he could return to work quickly.