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Background: Comminuted fractures of the metacarpals are both extremely painful and difficult for surgeons to repair. A strong, fast acting repair must be made to realign minute fragments of bone properly. Cyanoacrylate and demineralized bone matrix (DBM) have proven effective individually for certain repairs, but the efficacy of a combined treatment has not been confirmed. The purpose of this study is to test the strength of the repair when using a combined treatment of cyanoacrylate mixed with DBM in comminuted fractures. Methods: Sixteen metacarpals (2nd-5th) were collected from cadavers and fractured into three pieces at 30-degree angles to simulate a comminuted fracture. Three treatment groups were assessed: repair with cyanoacrylate glue (n=4), repair with cyanoacrylate and DBM combined (n=4), and repair using titanium plates and screws (n=8). Bones were pulled apart until repair failure with an Instron 5542 machine and the load at break (N) was recorded for each sample. IBM SPSS Statistics 24 was used to perform all statistical analysis. Independent sample t-tests were performed to compare group sample means. P-values < 0.05 were considered significant. Results: The titanium plate with screws repair demonstrated a significantly higher load at break across all metacarpals (avg=91.745 ± 12.575). There was no significant difference between the load at break for the cyanoacrylate glue (avg=39.855 ± 8.105) and the cyanoacrylate glue mixed with DBM groups (avg=28.664 ± 8.375). The 4th metacarpal produced the lowest load at break for the titanium plate with screws repair and the cyanoacrylate repair while the 5th metacarpal presented the lowest load at break for the cyanoacrylate mixed with DBM repair. Conclusions: The addition of DBM to cyanoacrylate does not significantly compromise the adhesive strength of cyanoacrylate. Titanium plates offer the strongest repair of the three groups. When bone fragments are too small to attach plates, the cyanoacrylate and DBM mixture creates a putty allowing easy realignment of the fragments while maintaining the strength of cyanoacrylate. This study was not conducive to examining DBM’s osteoinductive nor osteoconductive properties since all tests were done ex vivo. Further research should examine repairs over time using cyanoacrylate mixed with DBM in vivo. *Correspondence to: Wesley P Thayer, Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S., MCN D4207, Nashville, TN 37232-2345, USA, Tel: 615-936-3759; Fax: 615-936-0167; E-mail: wesley.thayer@vanderbilt.edu Received: June 22, 2018; Accepted: July 13, 2018; Published: July 18, 2018 Introduction Metacarpal fractures comprise roughly 40% of hand fractures [1]. When the majority of people refer to a “broken hand”, most likely they are referring to a fracture of one of the metacarpal bones. Injury can occur in the neck, shaft, or head of the metacarpals [1]. The fifth metacarpal is the most commonly injured metacarpal, usually caused by punching an object and commonly referred to as a “boxer’s fracture” [2]. The fractures can be identified as oblique, transverse, spiral, or comminuted [2]. Comminuted fractures of the hand are technical challenges that surgeons have to confront. The lack of bone infrastructure complicates fixation, obligating the patient to suffer longer periods of pain, immobilization and rehabilitation. Even when surgery is an available option, the demanding effort and long operative times are substantial. Comminuted fractures most commonly occur at the metacarpal head and generally have articular involvement [2]. Current surgical interventions include Kirschner wire (K-wire), screws, or plates. For comminuted fractures, K-wire is generally considered the best option due to its low invasiveness and long-term function [1]. K-wire, however, can lead to infection and requires a follow-up procedure with the patient to be removed. Bio-absorbable plates have shown promising results in cadaveric studies, but due to concerns about foreign body reactions after implantation need to be further studied before being used in patients [1]. Adhesives provide an alternative solution that is minimally invasive, offers strong fixation, and preserves soft tissue, blood supply, and trophic factors of bone [3]. Cyanoacrylate has shown recent promise as a strong adhesive that does not cause significant inflammatory responses when implanted [3]. Its use is very popular amongst surgeons as a common tool to close wounds and also as a final dressing. Cyanoacrylate’s various other uses include: dental adhesives, temporary repair of corneal perforations, drug carriers, controlling variceal bleeding, controlling hemorrhages, and non-load bearing cranio-facial skeletal procedures [3,4]. Cyanoacrylate offers the advantages of quick one-step application without the need for external energy, easy storage, and strong adhesions to multiple surfaces even in wet conditions [4]. Further testing needs to be completed to observe its efficacy for other possible injuries. Demineralized Bone Matrix (DBM) has gained attention due to its Stephanides M (2018) A novel repair for comminuted fractures in metacarpals: Combining cyanoacrylate with demineralized bone matrix Volume 2(4): 2-4 Surg Rehabil, 2018 doi: 10.15761/SRJ.1000144 easy availability along with its osteoconductive and osteoinductive properties [5]. Effectiveness of DBM can vary widely based on how it is processed, washed, and stored [5]. DBM has no risk of an immune response from the host due to its antigens being destroyed during the demineralization process [5]. Some literature recommends its use over autogenous bone grafts due to improved outcomes [6]. A combination therapy of cyanoacrylate mixed with DBM could provide a synergistic benefit for bone repair that has not been tested yet. This innovative combination adhesive needs to be tested against both cyanoacrylate by itself and against current hardware to prove its efficacy. The specific aim for this project is to test the strength of cyanoacrylate mixed with demineralized bone matrix to repair comminuted fractures in metacarpals. A novel technique is necessary to provide a simple and fast way to treat these difficult cases.