桡侧腕屈肌腱悬吊结合掌骨间韧带重建治疗第一腕掌关节骨关节炎

目的 评价大多角骨切除,桡侧腕屈肌腱悬吊结合掌骨基底间韧带重建治疗第一腕掌关节骨关节炎的疗效.方法 采用Schekker技术,应用大多角骨切除,桡侧半桡侧腕屈肌腱重建第一、二掌骨基底间韧带,并与剩余肌腱自身悬吊控制掌骨基底背侧半脱位,并形成肌腱填塞物内置大多角骨切除遗留空间控制掌骨下沉等手术步骤,治疗第一腕掌关节骨关节炎6例.术后手部功能评价指标包括握力(grip strength),捏力(key-pinch),第一腕掌关节直观模拟疼痛标尺法(visual analogue scales,VAS)及第一腕掌关节有效活动度评分(Kapandji score),术后12个月随访X线前后位片第一掌骨基底-舟骨远关节面间距,评价手术疗效.结果 术后随访时间为12～ 26个月,平均15个月.手术前后疼痛(VAS)平均分值为7.0/1.6;握力平均为11/22 kg;捏力平均为1.8/3.4 kg;Kapandji score 平均为6.0/8.7;12个月时测量X线前后位片第一掌骨基底-舟骨远关节面间距平均值为8.8mm.结论 大多角骨切除,桡侧腕屈肌腱动力性悬吊结合掌骨基底间韧带重建,最大程度地接近了该部位韧带解剖及生物力学方面的结构,可有效治疗第一腕掌关节骨关节炎.     

Fracture dislocations of the carpometacarpal joints of the fingers

ObjectiveFracture dislocations of the multiple carpometacarpal joints [CMCJ] of the fingers are uncommon injuries that can significantly compromise hand function and durability if managed sub-optimally. These injuries are at risk of being missed as they are commonly a part of major high energy trauma with associated more obvious and immediately threatening injuries getting all the attention. The clinical and radiological parameters which could help a surgeon to detect and analyse these injuries well are discussed. The management of these injuries with emphasis on the pattern of K-wire fixation is presented.MethodA review of multiple CMCJ dislocations at our institution found 39 hands in 38 patients (one case with bilateral injury) over a seven-year period (January 2010 to January 2017). The pattern of injury noted in these cases was assessed and categorized. Our preferred management plan for these injuries is discussed.ResultsThe patterns of dislocations noted in a total of 39 cases were-dorsal (25), dorsal radial (6), volar (1), volar radial (5) and divergent (2). The dorsal dislocations were the commonest (25/39) and additional 6/39 were radial-dorsal, only six displaced in a volar direction. Divergent dislocation was seen in only two cases.ConclusionThe pattern of dislocations noted in 39 cases in our institute (Ganga Hospital- A tertiary level trauma center) is presented to provide an overview of the spectrum of the injuries which a surgeon could face. Early surgery is recommended and should be aimed to restore perfect anatomical alignment of the skeleton. Surgeon should have a low threshold for open reduction in case of gross swelling or inability to get an anatomical closed reduction. The method of K-wire fixation presented herein has resulted in good outcome in our practice; wherein we fix the dislocated CMCJ by inserting K-wires from the radial and ulnar borders of the hand and avoiding wires in the central part of the hand. This prevents extensor tendons tethering by the K-wires. The fixation achieved by multiple K-wires passed in this manner provides enough stability to allow for early active mobilisation of the fingers. The need for careful assessment to detect associated nerve injury and compartment syndrome; and post-operative strict hand elevation and prevention of stiffness of the MCP joints has been emphasized.The CMCJ dislocations have innumerable patterns possible; however, the management principles remain the same. In spite of the gross distortion of the anatomy seen in these injuries, anatomical reduction and adequate stabilization to allow early mobilization generally results in satisfactory outcomes.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

Simple trapezectomy for treatment of trapeziometacarpal osteoarthritis of the thumb

Summary This is a review of 20 patients (22 operations) with symptomatic osteoarthritis of the first carpometacarpal joint who were treated by simple trapezectomy without interposition material. They were all women with a mean age of 60 years (46–77). The average follow-up was 2 years, ranging from 8 months to 3 years. Pain relief is the main contributor to the good clinical results of this procedure. Sixteen patients professed to be very satisfied, two had a fair result and four cases claimed to be unsatisfied. Range of motion (opposition and counter opposition) and first web space were very well preserved. Mean values of grip strength showed reduction of grip power on the operated side though not statistically. However, we did find a statistically significant difference in pinch strength between operated and non-operated side.In general, simple trapezectomy is our preferred surgical therapy in the treatment of carpometacarpal osteoarthritis in the elderly population.     

Complex fracture-dislocation of the carpometacarpal joint associated with a fracture of the hamate: a case report

Abstract We report a case of carpometacarpal dislocation associated with a fracture of the hamate, an extra-articular fracture of the base of the first metacarpal and a rotated volar dislocation of the scaphoid. These lesions are not common and are sometimes misdiagnosed because of nonspecific symptoms and the difficulty of interpreting the radiographs. Open reduction and stabilization with Kirschner wires was performed. We removed the cast and wires after 4 weeks and the patient was sent to a rehabilitation program. When reviewed 18 months later, he had recovered complete hand function without pain or other symptoms, even after heavy manual activities.     

The axes of rotation of the thumb carpometacarpal joint.

Two axes of rotation of the carpometacarpal (CMC) joint of seven cadaver thumbs were located using an axis finder. The flexion-extension axis is located in the trapezium and the abduction-adduction axis is in the first metacarpal. These axes are fixed, are not perpendicular to each other or to the bones, and do not intersect. Motion of the first metacarpal on the trapezium can be defined by these two axes. Understanding of the movements of the basal joint of the thumb is essential to the study of its function and reconstruction.