Although most reports of the functional results of replantation at the metacarpal level have been poor, the author (LRS) has reported good functional results with the early use of the dynamic crane outrigger splint with a MCP joint extension block, as described in this article (Fig. 8). Promoting early protective active motion and blocking MP joint extension [figure: see text] help achieve a hand with an intrinsic-plus posture and coordinated grasping. Although this protocol does not show an improvement over the functional results at the wrist and distal forearm reported by Meyer, its use can help prevent intrinsic-minus deformity, which is a concern in most amputations proximal to the MCP joint, according to Russell et al. With this technique, the need for subsequent surgery is reduced. Tenolysis may be needed in some patients, but it should not be performed until 6 months postoperatively.