Current concepts in managing fractures of metacarpal and phalangess

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon''s work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.     

Experiences with rigid internal fixation using a low volume titanium implant system in metacarpal and phalangeal fractures

Our experience using the low volume titanium mini-fragment system ”Profile Titan” is presented retrospectively. The system contains self-tapping miniscrews with countersinking heads and very small adaptable plates with rounded edges. The study consists of 53 patients who underwent osteosynthesis, arthrodesis, or corrective osteotomy of the hand skeleton from 1 January 1994 to 31 March 1995. Functional results were evaluated and standard postoperative X-rays were taken at 1, 2, and 4 weeks after injury. Fifty-three patients with 56 fractures were treated. Results show that 78% of patients regained complete recovery of active range of motion. Fractures with and without negative prognostic factors were compared. There were three major postoperative complications not related to the type of implant. Compared to the AO mini system this system has several advantages. Received: 16 April 1998 / Accepted: 19 October 1998     

西脉环抱式接骨板内固定治疗掌指骨骨折

目的 探讨西脉环抱式接骨板内固定治疗掌指骨骨折的疗效。方法 对29例43处掌指骨骨折采用西脉钛合金指掌骨环抱式接骨板进行内固定治疗。结果 术后随访3～12个月，骨折愈合率达100％。患手掌指关节和指间关节功能恢复正常。结论 对于外伤性掌指骨骨折，采用西脉指掌骨环抱式接骨板进行内固定治疗，配合术后早期活动锻炼，可取得满意的治疗效果。     

微型外固定器治疗掌指骨骨折

目的探讨应用微型外固定器治疗手掌指骨骨折的方法及疗效。方法对28例手掌指骨骨折应用微型外固定器治疗。结果术后随访5个月~1年,平均8个月,25例达到解剖复位,2例对位稍差,1例对位欠佳。25例愈合顺利,3例愈合延迟。按ATM法评价术后手指活动度,本组优17例,良9例,可1例,差1例。优良率达92.86%。结论微型外固定器治疗手部掌指骨骨折创伤小,固定可靠,愈合率高,利于早期功能锻炼,有良好的治疗效果。     

骨牵引治疗掌指骨粉碎性骨折

2005年～2011年8月,我院对48例掌、指骨粉碎性骨折患者采取指骨牵引治疗,取得较好的疗效。1材料与方法1.1病例资料本组48例,男40例,女8例,年龄18～58岁。骨折部位:掌骨骨折9例,指骨骨折39例(其中近节     

手部外固定架的设计及临床应用

目的探讨手部小管状骨骨折,特别是关节附近的掌、指骨骨折,及其粉碎性骨折的更为简便有效的治疗方法,介绍一种新型实用的手部外固定架.方法自1996年10月采用自行设计的手部外固定架治疗掌、指骨骨折30例.其中掌、指骨干骨折18例,掌、指骨头骨折12例;闭合骨折25例,开放骨折5例;单纯骨折24例,粉碎骨折6例.结果平均随访4.5个月,骨折愈合时间4～8周,无骨不连及骨髓炎并发症.手功能恢复按TAM标准优22例,良4例,可4例,优良率86.7%.结论手部外固定架结构简单,方便实用,固定掌、指骨稳固,特别是对掌、指骨头骨折,以及粉碎性骨折有良好的固定作用.     

Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand

Background:

Optimized functional results are difficult to achieve following hand injuries. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalangeal fractures.

Materials and Methods:

Forty-five fractures of digits of hand in 31 patients were managed by surgical stabilization. Five fractures were fixed with closed reduction and percutaneous Kirschner wire fixation; 10 with external fixator; 26 with open reduction and Kirschner wire fixation; and four with open reduction and plate and screw or screw fixation.

Results:

Final evaluation of the patients was done at the end of three months. It was based on total active range of motion for digital functional assessment as suggested by the American Society for surgery of hand. Overall results were excellent to good in 87%. Better total active range of motion (excellent grade) was observed in metacarpal fractures (47%) versus phalanx fractures (31%); closed fractures (57%) versus open fractures (27%); and single digit involvement (55%) versus multiple digits (29%). Excellent total active range of motion was observed with all four plate and screw/ screw fixation technique (100%) and closed reduction and percutaneous kirschner wire fixation (60%). Twenty-two complications were observed in 10 patients with finger stiffness being the most common.

Conclusion:

Surgical stabilization of metacarpal and phalangeal fractures of hand seems to give good functional outcome. Closed fractures and fractures with single digit involvement have shown a better grade of total active range of motion.     

Multiple intramedullary nailing of proximal phalangeal fractures of hand

Background:

Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique.

Materials and Methods:

Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength.

Results:

All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient.

Conclusion:

Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.     

微型钢板内固定治疗掌指骨骨折

目的 探讨微型钢板内固定治疗掌指骨骨折的疗效。方法 对14例26处掌指骨骨折，采用国产微型钢板进行内固定治疗。结果 术后随访2～12个月，骨折全部愈合。按TAM评价，功能优8例，良4例。结论 微型钢板内固定操作简单，固定可靠，辅以术后早期功能锻炼，可得到满意的治疗效果，是治疗掌指骨骨折较理想的固定方法。     

微型钢板内固定治疗掌指骨骨折

2000年1月～2004年12月,我们应用微型钢板内固定治疗掌指骨骨折16例,疗效满意。1材料与方法1.1病例资料本组16例,男12例,女4例,年龄18～52岁。骨折部位:掌骨骨折11例,指骨骨折5例。骨折类型:横形7例,短斜形5例,粉碎性4例。闭合性10例,开放性骨折6例。新鲜骨折14例,陈旧性骨折2例。6例伴有肌腱损伤。急诊手术内固定3例。1.2治疗方法臂丛麻醉及气压止血带下手术。开放性骨折常规彻底清创后手术。掌骨骨折取伸肌腱旁侧纵形切口,指骨骨折用侧正中纵形切口。根据骨折部位及类型,选用L、T形或直形钢板螺钉固定。骨折固定牢稳者术后不用外固定;严…     

Operative treatment of articular fractures of the hand

Articular fractures of the hand present a formidable challenge to the treating physician. The goal is restoration ofarticular congruity, preservation of joint stability, and return of hand function. The treatment algorithm is different, depending on the particular joint, degree of instability, and amount of articular involvement. The surgical technique requires careful handling of the soft tissue and the small fracture fragments. Fracture fixation may be accomplished by miniscrews, K-wires, or tension band wiring. Early motion is initiated if rigid fixation is obtained. Outcome varies with the severity of injury and ability to restore articular and joint alignment. This article discusses the operative treatment of articular fractures at the interphalangeal, metacarpophalangeal, and carpometacarpal joints of the hand.     

Double parabolic Kirschner-wires as dynamic distractor for treatment of unstable intraarticular phalangeal fractures of hand

Background:

Treatment of complex injuries of interphalangeal joints (IPJs) is difficult. The restoration of joint stability for early joint mobility till fracture union is the key for successful outcome. Although various treatment options like dynamic splinting, external fixator, closed reduction, transarticular Kirschner (K)-wire and ORIF, etc., are available in literature, a universally accepted ideal treatment for complex intraarticular fractures of IPJs is still evolving. Open reduction is difficult because fixation of volar fragment is often impractical and radical procedures like volar plate arthroplasty, arthrodesis or joint replacement, etc., may become mandatory for salvage. We describe percutaneous technique to treat unstable fractures and dorsal fracture–dislocations of the PIP joint and report short-term postoperative results.

Materials and Methods:

Ten cases of unstable or potentially unstable intraarticular fractures including pilon fractures and fracture-dislocations of IP joints were treated percutaneously by double parabolic K-wire technique (DPK). The device was used as a dynamic distraction, using the principle of ligamentotaxis. The idea was to commence early postoperative continuous active and active-assisted joint motion exercises and to carry on the frame as a definitive treatment for achieving fracture union.

Results:

In all patients of fracture-dislocation the reduction was satisfactory and early mobility was achieved. Although there is a tendency towards over-distraction, no loss of reduction occurred. Pin tract infection occurred in one with no delayed union or nonunion. The average total range of motion for each involved IP joint was 93.5 degree and the average total active range of motion was 90.8° each at the end of 4 months followup. Excellent to good results were restored in nearly all cases without further interventions.

Conclusion:

DPK technique may be a cheap and valuable definitive treatment option in the management of unstable or potentially unstable intraarticular fractures of IPJs. The technique gave satisfactory radiological union and functional outcome in our small series. This technique may be worth considering in unstable or potentially unstable intraarticular fractures of IPJs with intact collateral ligaments and when other treatment options are impractical.     

微型钢板内固定与克氏针内固定治疗掌指骨骨折的Meta分析

目的 通过Meta分析比较微型钢板内固定与克氏针内固定治疗掌指骨骨折的临床疗效.方法 检索自2010-01-2020-12收录在中国知网、Pubmed等数据库关于比较微型钢板内固定(微型钢板组)与克氏针内固定(克氏针组)治疗掌指骨骨折的相关文献,采用RevMan 5.3软件进行Meta分析.比较微型钢板组与克氏针组功能...     

外固定架治疗掌指骨骨折

掌、指骨骨折为手部常见损伤，若治疗不当易发生畸形愈合、肌腱粘连、关节僵硬等并发症，严重影响手功能的恢复。我院自1998—2001年对48例54处掌指骨骨折患者进行外固定架治疗，效果满意，报告如下。     

Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals

Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.     

Technique of olecranon bone grafting for surgical fixation of scaphoid fractures

Currently described sources of bone graft, such as iliac crest and distal radius, for supplemental fixation of scaphoid fractures are suboptimal. In our experience, olecranon bone has the advantage of providing a convenient source of corticocancellous block graft that can be harvested within the same sterile operative field used for fixation of the scaphoid fracture, and it also causes less postoperative pain compared to that obtained from iliac crest. Here, we describe our surgical technique for harvest and use of olecranon bone graft for fixation of scaphoid fractures.     

微型外固定器治疗Bennett骨折

目的探讨应用外固定器治疗Bennett骨折的临床效果。方法采用微型外固定架牵引固定Bennett骨折21例。结果21例术后随访3～18个月,骨折临床愈合时间5～9周,平均6.7周,关节功能恢复良好。按照TAM系统评定,优良率达90.5%。结论外固定器治疗Bennett骨折是一种有效的外固定治疗方法。