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MINI EXTERNAL FIXATION DEVICE FOR COMMINUTED OPEN FRACTURES OF METACARPAL AND PHALANGE

Objective To explore the effectiveness of mini external fixation device for comminuted open fractures of the metacarpal and phalange. Methods Between October 2009 and April 2011, 33 patients with comminuted open fractures of the metacarpal and phalange were treated with mini external fixation device. There were 25 males and 8 females, aged from 21 to 62 years with an average of 25.5 years. Of 33 cases, 7 were rated as Gustilo type II and 26 as Gustilo type IIIA; 20 cases were diagnosed as having simple metacarpal and phalangeal comminuted fractures and 13 cases as having combined interphalangeal or metacarpophalangeal joint fractures. Partial or complete rupture of tendon was observed in 18 cases. The time between injury and operation was 2-8 hours (mean, 3.7 hours). After one stage debridement and reduction, fracture was fixed with mini external fixation device. Results Primary healing of incision was obtained in 30 cases and no pin hole infection was found. Incision infection occurred in 3 cases and leaded to nonunion. Nonunion also occured in 2 cases of simple metacarpal and phalangeal fractures. The mean follow-up was 8 months (range, 6 months to 1 year). X-ray films showed fracture healing in 13 cases after 8 weeks (8 cases of simple metacarpal and phalangeal fractures and 5 cases of combined interphalangeal or metacarpophalangeal joint fractures), in 12 cases after 12 weeks (7 cases of simple metacarpal and phalangeal fractures and 5 cases of interphalangeal or metacarpophalangeal joint fractures), and in 3 cases of simple metacarpal and phalangeal fractures after 6 months. After removing the mini external fixation device and functional exercise, 3 cases of simple metacarpal and phalangeal comminuted fractures and 4 cases of combined interphalangeal or metacarpophalangeal joint fractures still had joint stiffness, but had no finger rotation and alignment deformity or chronic pain. According to the measurement of total active movement for 28 patients who obtained fracture healing, the results were excellent in 7 cases, good in 12 cases, fair in 5 cases, and poor in 4 cases, the excellent and good rate was 67.9%. Conclusion The mini external fixation device is a good technique for comminuted open fractures of metacarpal and phalange. In patients having comminuted open fractures with interphalangeal or metacarpophalangeal joint fracture, the results are fair or poor.

指骨骨样骨瘤二例报告

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PROGRESS OF METACARPAL AND PHALANGE LENGTHENING

Objective To review the methods of metacarpal and phalange lengthening and to point out the problems at present as well as to predict the trend of development in the field. Methods Domestic and abroad l iterature concerning the methods of metacarpal and phalange lengthening in recent years was reviewed extensively and thoroughly analyzed. Results At present, there are many methods to treat the short finger disabil ity, but the methods of metacarpal and phalange lengthening have an advantage, which include closed osteotomy lengthening, callus-lengthening, and modified Il izarovmethod. Each surgical method has its advantages and l imitations. However, the part of osteotomy, the length and speed, and the postoperative compl ications etc. have been disputed. Conclusion The modified Il izarov method has the advantages of simple operation, minimal invasion, and less compl ications, but the long-term results of each treatment method are unknown and need more further studies.

微型钢板治疗掌指骨骨折的疗效分析

目的 回顾性分析微型钢板治疗掌、指骨骨折的效果，评价其临床应用价值。 方法 2003 年1 月－2007 年6 月，采用微型钢板治疗掌、指骨骨折134 例174 处。男101 例，女33 例；年龄15 ～ 48 岁，平均27.8 岁。掌骨骨折105 处，指骨骨折69 处。闭合性骨折71 处，开放性骨折103 处。其中粉碎性骨折68 处，斜形或螺旋形骨折46 处，横形骨折32 处，粉碎性骨折合并骨质缺损13 处，病理性骨折（内生软骨瘤）合并骨质缺损15 处。合并伸屈肌腱损伤或神经损伤18 处，皮肤缺损11 处，累及关节的骨折16 处。伤后至手术时间2 ～ 72 h，平均6 h。 结果 术后伤口除1 例感染外，均Ⅰ期愈合。皮瓣供区Ⅰ期愈合。患者均获随访，随访时间6 ～ 12 个月，平均8.2 个月。X 线片示骨折线于术后6 ～ 11周消失。伤指外观无明显成角及旋转畸形。术后因疼痛不愿活动致关节僵硬3 指，累及关节的骨折致创伤性关节炎1 指，延迟愈合2 指，伤口感染1 指。无骨不连及畸形愈合。按照TAM 系统评定法，优115 处，良39 处，可12 处，差8 处，优良率88.5%。 结论 微型钢板治疗掌指骨骨折是一种有效的内固定方法

FORWARD HOMODIGITAL ULNARIS ARTERY FLAP COVERAGE FOR BONE AND NAIL BED GRAFT IN THUMB FINGERTIP AMPUTATION

Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf

远节指骨内生性软骨瘤临床分析

总结远节指骨内生性软骨瘤的临床特点及治疗方法。 方法 2000 年1 月－ 2008 年4 月，收治7 例远节指骨内生性软骨瘤患者。男2 例，女5 例；年龄5 ～ 35 岁。中指3 例，环指2 例，示、小指各1 例。其中4 例多发，合并其他掌、指骨内生性软骨瘤；3 例单发。术中取手指侧方入路，刮除肿瘤，其中2 例肿瘤横径gt; 1 cm 者移植冻干异体髂骨块修复肿瘤刮除后造成骨折和骨缺损。 结果 术后切口均Ⅰ期愈合。患者均获随访，随访时间6 ～ 24 个月。患指外形均满意，骨质均愈合，肿瘤无复发。除2 例植骨患指因固定时间较长，远指间关节屈伸受限外，余患指活动无明显影响。 结论 远节指骨内生性软骨瘤早期手术可获得良好效果。

微型外固定支架重建掌指骨支架

A COMPARATIVE STUDY ON TWO DIFFERENT ABSORBABLE INTRAMEDULLARY NAILS IN TREATING METACARPAL AND PHALANX FRACTURES

Objective To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures.Methods From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures( 52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 casesand media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases.Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group). Results In the PDLLA group(n=24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; therejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n=36), the rejection occurred in 1 case 19 days after operation, but therejection subsided after 3 days of conservative treatment.No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 monthswith an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks(8 weeks onaverage). There was statistically significant difference in the curative resultbetween two groups(Plt;0.05). Conclusion Intramedullary nail of PDLLAwas verysuitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan,PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased.PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.

Clinical Research of Mini-plate for the Treatment of Metacarpal and Phalangeal Fractures and Early Rehabilitation

ObjectiveTo discuss the clinical curative effect of internal fixation for metacarpal and phalanx fractures using stainless steel mini-plate and the early rehabilitation. MethodsThe study included 47 cases treated from January 2006 to June 2011, including 25 cases of 72 phalangeal fractures, 17 cases of 43 metacarpal fractures, and 5 cases of 23 complex metacarpal and phalangeal fractures. All the patients underwent open reduction and micro-plate internal fixation. Three days after surgery, passive function training was initiated. Patients accompanied with blood vessel damage began the training one week later. The training was carried out based on the early rehabilitation schedule. ResultsPrimary healing occurred in all the 47 cases. There was one case of broken plate because of crashing. Postoperative follow-up lasted for 4 to 10 months, and the fractures were healed in 138 lesions. X-ray examination showed that bone union took place at week 8 to 11 averaging at 10. According to the functional evaluation of total autive movement scales, the excellent and good rate was 83.0%. ConclusionThe stainless steel mini-plate in the treatment of metacarpal and phalangeal fractures has a firm fixation and is advantageous. Combined with early rehabilitation training, it can maximize the recovery of hand function with satisfactory clinical results.

克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折

目的总结克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折的疗效。 方法2008年9月－2014年3月，对15例远节指骨背侧基底不稳定骨折患者采用切开复位、克氏针双夹扣法固定。男12例，女3例；年龄18～53岁，平均32.5岁。致伤原因：戳伤8例，扭伤2例，摔伤3例，挤压伤2例。损伤指别：示指5例，中指3例，环指2例，小指5例。受伤至手术时间2～9 d，平均3.8 d。 结果患者术后切口均Ⅰ期愈合。15例均获随访，随访时间6～20个月，平均12.5个月。X线片示骨折均愈合，愈合时间5～8周，平均6.1周。术后8～12周，平均9.2周取出内固定物。末次随访时，根据总主动活动度（TAM）评价标准评定手指功能，获优9例，良5例，中1例，优良率93.3%。 结论克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折，可使骨折、关节复位且固定牢固，允许手指早期功能锻炼，是一种有效治疗方法。