闭合穿针治疗掌指关节周围部位骨折

目的 探讨闭合穿针治疗掌指关节周围部位骨折的临床疗效.方法 2005年以来,对17例掌骨颈或近节指骨基底部骨折患者,采用C型臂X线机透视下闭合复位克氏针内固定治疗.单部位骨折11例,其中掌骨头或颈部骨折7例,近节指骨基底部骨折4例;多部位骨折6例,其中2处以上掌骨颈骨折3例,2～5指近节指骨基底部均骨折1例,2～4指近节指骨基底部均骨折1例,第五掌骨颈骨折伴环指近节指骨基底部骨折1例.均为闭合性骨折.急诊手术4例,伤后5 d内手术12例,伤后11 d手术1例.术后2-3周拆除石膏,4周拔克氏针.结果 术后X线片显示骨折均达到良好复位.随访6～9个月,骨折愈合良好.手功能按TAM系统评定法评定:优13例,良4例.结论 闭合穿针治疗掌指关节部位骨折创伤小、方法简单、疗效佳,是治疗掌指关节部位骨折理想的方法.     

微型钛板掌侧固定治疗手指近节指骨骨折

目的 分析应用微型钛板掌侧固定治疗近节指骨骨折的可行性和可靠性.方法对15例18指闭合性近节指骨骨折,做掌侧“Z”形切口,骨折复位后应用微型钛板内固定.术后2d开始主动屈、伸手指进行功能锻炼.术后1周内测定手指中节和末节感觉.结果术后患指中、末节均无感觉障碍.随访时间为4～8个月,18指骨折全部愈合,未见畸形愈合,骨折临床愈合时间为6～ 10周,无关节僵直、肌腱粘连等并发症.按手指关节总活动度(TAM)法进行功能评定:优16指,良2指.结论采用微型钛板掌侧固定治疗手指近节指骨掌侧骨折,手术操作简便,固定可靠,可作为指骨掌侧骨折的治疗方法之一.     

微型钢板放置指骨背侧与侧方在治疗近节指骨骨折的临床对比

目的 分析比较微型钢板治疗近节指骨骨折放置指骨背侧与侧方对恢复手功能的临床效果.方法 2009年6月-2011年6月,对62例71指近节指骨骨折患者行切开复位内固定治疗.A组：40例45指近节指骨骨折,切开复位微型钢板固定在指骨背侧;B组：22例26指近节指骨骨折,切开复位微型钢板固定在指骨侧方.术后对骨折愈合时间、并发症及术后手功能恢复情况进行比较分析.结果 术后随访4～24个月,平均11个月.按TAM系统评价法评定：A组优12指,良15指,中12指,差6指;优良率为60％.B组优18指,良6指,中2指,差0指;优良率为92％.两组在骨折愈合时间、感染率上差异无统计学意义.结论 治疗手指近节指骨骨折将微型钢板放置在指骨侧方,肌腱粘连和伸指功能障碍明显减少,手指功能恢复良好;缺点是生物稳定性较放在指骨背侧差.     

7号注射器针头治疗末节指骨骨折伴甲床损伤105例体会

目的探讨7号注射器针头内固定治疗末节指骨骨折伴甲床损伤的效果。方法对105例110手指末节指骨骨折伴甲床损伤患者用7号注射器针头由远端骨折处逆行穿出再顺行穿入直达基底行内固定治疗,使之解剖复位,再用尼龙5∕0肌腱套针缝合甲床。结果术后随访2个月～1年,105例110指末节指骨骨折104指Ⅰ期愈合,6指Ⅱ期愈合,指甲全部不同程度生长,末节指间关节功能良好。结论 7号注射器针头内固定治疗末节指骨骨折伴甲床损伤疗效确切、方法简单、取材方便,非常适合门急诊和基层医疗单位使用。     

微型钢板在治疗手部指骨骨折中的应用

目的 介绍应用微型钛质钢板治疗指骨骨折的临床疗效.方法 2009年7月至2010年7月,对65例手指骨折,根据骨折不同部位采取切开复位,放置微型钢板内固定.其中近节指骨40例,中节指骨25例,并对术后疗效进行评价.结果 术后随访时间为6～ 12个月,平均8个月.根据手指关节总活动度(TAM)评分:优50例,良10例,可5例;优良率为92.3％.术后患者均无伤口感染、骨折畸形愈合和骨不连发生,无钢板外露、钢板突出、螺钉松动等并发症.结论 应用微型钢板治疗指骨骨折,宜针对不同骨折部位放置钢板进行固定,疗效可靠,并发症少.     

克氏针与钢丝联合应用治疗指骨斜形骨折

目的:介绍克氏针与钢丝联合应用治疗指骨斜形骨折的可行性与优点。方法:76例手指骨近节指骨或中节指骨斜形骨折患者采用手术中克氏针与钢丝联合应用使骨折复位并固定。结果:72例骨折愈合良好,手指活动自如,2例畸形愈合,2例因术后感染而将内固定物取出。结论:克氏针与钢丝联合应用治疗指骨斜形骨折疗效可靠。     

克氏针背侧阻挡加压骨折块法治疗骨性锤状指

末节指骨基底背侧撕脱骨折并伸肌腱止点损伤常见于青壮年.外伤致手指Ⅰ区指伸肌腱断裂伴远节指骨基底背侧撕脱骨折,表现为手指远指间关节屈曲、背伸不能的一种畸形称为骨性锤状指.X线侧位片可见末节指骨背侧撕脱骨折向背侧移位.2006年2月至2011年5月,我科采用克氏针背侧阻挡加压骨折块法治疗骨性锤状指52例,效果良好.     

中节指骨基底背侧撕脱骨折的手术治疗

目的探讨应用克氏针内固定中节基底背侧较大撕脱骨折块和中节指骨基底背侧钻孔缝合治疗中节指骨基底背侧小片撕脱骨折的疗效。方法对60例中36例骨折块较大的中节基底背侧撕脱骨折患者采用骨折复位,0.8mm克氏针内固定骨折块,并首先顺行穿入1.0mm克氏针行近指间关节(pip)平伸位内固定;对24例骨折块小的中节指骨基底背侧撕脱骨折采用骨折复位,中节基底背侧钻孔缝合,同时顺行1.0mm克氏针内固定PIP于平伸位。石膏托外固定掌指关节(MP)80°～90°屈曲位,腕关节背伸位,远指间关节(DIP)平伸位3～4周。术后4～6周拔除内固定骨折块及PIP关节克氏针。结果经术后3～9个月的随访,按指关节主动运动总和(TAM)法评定疗效:优15例,良35例,中10例,骨折全部愈合。结论采用克氏针内固定中节基底背侧较大撕脱骨折块及中节基底背侧钻孔治疗中节背侧小片撕脱骨折的两种手术方法疗效均满意。     

内固定治疗闭合性近侧指间关节背侧脱位伴中节指骨掌侧基底骨折

目的 探讨内固定治疗闭合性近侧指间关节背侧脱位伴中节指骨掌侧基底骨折的疗效.方法 对20例闭合性近侧指间关节背侧脱位伴中节指骨掌侧基底骨折的患者行克氏针内固定治疗,术后指体用微型支具或石膏托固定3～4周,并进行功能恢复性锻炼.结果 20例均获随访,时间3～6个月.X线片示骨折复位愈合、关节在位.近侧指间关节主动屈伸活动范围:伸0～20(18±1)°,屈30～90(68±5)°;被动屈伸活动范围:伸5～20(15±2)°,屈50～100(78±8)°.结论 内固定手术治疗闭合性近侧指间关节背侧脱位伴中节指骨掌侧基底骨折效果较好.     

微型拉力螺钉在近节指骨骨折中的应用

目的介绍应用微型拉力螺钉治疗近节指骨骨折的临床效果。方法对82例91指近节骨折采用骨折复位拉力螺钉内固定方法治疗,术后按手指关节总活动度(TAM)进行评价。结果术后随访时间为5周~12个月,平均7个月,术后手指功能根据评分标准判定:优73指,良15指,可3指,优良率96.7%。结论应用微型拉力螺钉治疗近节指骨骨折,具有损伤小、术后并发症少等优点,是治疗近节指骨骨折较理想的方法。     

Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base

BackgroundQuantitative 3-dimensional computed tomography (3DCT) analyses can provide a more detailed understanding of fracture morphology. For fracture-dislocation of the proximal interphalangeal joint, the extent of fragmentation of the volar lip of the middle phalanx—a factor that might influence treatment—is not always apparent from radiographs. We hypothesized that there is no correlation between number of fracture fragments and the percentage of articular surface area involved in intra-articular fractures of the base of the middle phalanx using quantitative 3DCT analyses.MethodsWe used 13 computed tomography scans with a slice thickness of 1.25 mm or less to create 3-dimensional models of 15 intra-articular fractures of the base of the middle phalanx in 13 patients. We resized 3-dimensional models of a non-fractured middle phalanx of the same hand to fit the fractured middle phalanx in order to approximate the size and shape of the fractured middle phalanx in its pre-injury state. We created a heatmap to demonstrate the location of the fractured articular surface.ResultsWith the number of scans available, we did not find a significant correlation between the percentage of articular surface area involved and the number of fracture fragments. The median percentage of articular surface area involved was 46 % (range, 21–90 %). The heatmap demonstrated that the radio-volar side of the articular surface seems to be more involved than the ulnar-volar side in intra-articular fractures of the base of the middle phalanx.ConclusionQuantitative 3DCT analysis of fracture fragments provides useful information that could facilitate surgery and analysis of complex fractures of the base of the middle phalanx.Level of Evidence: IV, Basic Science Study, Anatomic Study, Imaging.     

Fractures of the phalanges of the hand in children.

Fractures of the phalanges of the hand were studied in 203 children. Fingertip fractures caused disability for three weeks but usually had good results. Comminuted fractures often took the form of longitudinal splitting. Epiphyseal fractures were mostly of the Salter type 2 and metaphyseal types and usually had good results: remodelling occurred in both planes at the base of the proximal phalanx but only in the sagittal plane at the base of the middle phalanx. Epiphyseal fractures at the base of the distal phalanx often had unsatisfactory results. Fractures of the neck of phalanx showed no remodelling at all and if deformity is not corrected it is probably permanent.     

Results of osteotomy, open reduction, and internal fixation for late-presenting malunited intra-articular fractures of the base of the middle phalanx

PURPOSE: To present our results in the treatment of late-presenting impaction fractures of the base of the middle phalanx treated by osteotomy with full exposure of the articular surface to restore the normal anatomy. METHODS: Eleven patients with a malunited (impacted) fracture of the base of the middle phalanx were treated by osteotomy more than 5 weeks after the injury. All fractures had varying degrees of impaction, comminution, and dorsal subluxation. The malunited joint surface was visualized by dislocating the joint by hyperextension (shotgun approach). The restoration of the cup-shape contour of the middle phalangeal base was accomplished by osteotomy and mobilization of small osteochondral fragments. Rigid fixation was performed by cerclage wire, screws, or a combination of these. A distal radius bone graft was placed beneath disimpacted fragments in 9 of the 11 procedures. RESULTS: Ten of 11 patients were followed-up for more than than 1 year. One patient with a volar lateral impaction fracture was lost to follow-up study 4 weeks after the surgery and was excluded from the results. All patients except 1 achieved a functional range of motion of the proximal interphalangeal joint. Moderate limitations of the distal interphalangeal joint motion were common. Grip and thumb-affected finger tip pinch strengths were 95% and 90%, respectively, of the healthy side. The average pain level (as rated on a visual analog scale of 0-10) improved from a preoperative score of 9.1 to a postoperative score of 0.8. One patient was somewhat dissatisfied; all other patients were satisfied or very satisfied. All returned to their previous work at an average of 13 weeks after surgery. CONCLUSIONS: Favorable results have been achieved in this challenging scenario in the short- and middle-term in 9 of 10 patients. Previous surgery and moderate to severe wearing of the cartilage of the proximal phalanx head negatively affected the results.     

Unstable fracture dislocations of the proximal interphalangeal joint. Treatment with the force couple splint

The force couple splint maintains concentric joint reduction while allowing early active range of motion exercises. Sixteen cases were treated with a force couple created across the proximal interphalangeal (PIP) joint, levering the dislocated base of the middle phalanx palmarly, while simultaneously lifting the distal end of the proximal phalanx dorsally to restore joint reduction. The splint is constructed from three Kirschner wires and is activated by a single rubber band. The effect of this force couple is present through a complete range of joint motion, thereby allowing active flexion and extension of the joint during bone and soft tissue healing. The force couple splint is capable of producing good to excellent results in patients with unstable acute fracture dislocations of the PIP joint.     

Dorsal fracture subluxation of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb treated by extension block splintage.

In a prospective study six patients with dorsal fracture subluxation of the IP joint of the thumb or the DIP joint of the finger were treated conservatively using an extension block splint. The fracture size varied from 22% to 47% of the articular surface of the volar base of the terminal phalanx. Good or excellent results were reported in all cases except for one, which was fair. Only one case in the study complained of any pain, and this was minimal. Conservative treatment using extension block splintage for this injury is as good as a surgical approach.     

末节指骨基底背侧撕脱骨折的手术治疗

目的介绍应用克氏针和抽出钢丝固定末节指骨背侧撕脱骨折的手术方法。方法对21例末节指骨背侧撕脱骨折，采用切开复位，末节指骨过伸位，顺行或逆行穿入克氏针，再加抽出钢丝加强撕脱骨块固定的方法。术后撕脱骨折全部解剖复位。4周拔除克氏针，6周拔出钢丝。结果术后随访3个月，按TAM法评定疗效：优16例，良5例，优良率达100％。骨折全部愈合。结论采用克氏针和抽出钢丝固定末节指骨背侧撕脱骨折，能有效治疗锤状指畸形，手术方法简便，疗效满意。     

自制简易外固定牵引支架结合克氏针固定治疗近中节指骨干粉碎性骨折

目的：探讨应用自制简易外固定牵引支架结合克氏针固定治疗近、中节指骨干粉碎性骨折的方法和疗效。方法2009年6月-2013年8月,对26例（32处）近、中节指骨粉碎性骨折患者采用自制简易外固定牵引支架结合克氏针及可吸收线固定治疗,并定期随访,观察疗效。结果术后所有病例骨折均愈合,无骨髓炎发生,未出现骨折移位或畸形愈合,有9处骨折在愈合过程中形成外骨痂。按照手指总主动活动度（tatol active motion, TAM）的评级标准并参考手指总主动屈曲度（tatol active flexion, TAF）的评分标准,评定患指运动功能,优5例（5处）,良16例（17处）,可3例（6处）,差2例（4处）;病例优良率80．8％（骨折部位优良率68．8％）。结论应用自制简易外固定牵引支架结合有限内固定治疗近、中节指骨粉碎性骨折方法可靠,手术创伤小,能有效固定骨折,早期进行功能锻炼,恢复手指的运动功能。     

The treatment of dorsal fracture-dislocation of the proximal interphalangeal joint by closed reduction and Kirschner wire fixation: a 16-year follow up

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30-60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 8 degrees at the proximal interphalangeal joint, which had a mean arc of movement of 85 degrees. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.     

The relative incidence of fractures at the base of the proximal phalanx of the thumb in children

There is disagreement in the literature about the most common fracture type at the base of the proximal phalanx of the thumb in children below the age of adolescence. In this prospective study, 58 consecutive children aged 10 years or less with isolated fractures of the base of the proximal phalanx of the thumb were included and their radiographs were reviewed. The study included 38 boys and 20 girls with a mean age of 8 (range 1-10) years. After excluding one patient, in whom the type of fracture could not be determined, the most common fracture in the remaining 57 cases was the Salter-Harris type II fracture (72%), followed by the juxta-epiphyseal type II fracture (18%).