ObjectiveTo explore the influence factors of the surgical effectiveness for solitary enchondroma of the hand with pathologic fracture. MethodsA retrospective analysis was made on the clinical data of 65 patients with solitary enchondroma of the hand with pathologic fracture who were treated with operation and were accorded with selective standard between March 2010 and June 2013.There were 26 males and 39 females,aged 17 to 63 years (mean,36 years).The left hands were involved in 32 cases and the right hands in 33 cases.The tumor located at the metacarpus in 18 cases,and at the phalanx in 47 cases (at the proximal phalanx in 30 cases,at the middle phalanx in 9 cases,and at the distal phalanx in 8 cases).The duration from fracture to operation was 2 days to 2 years (mean,56 days).The operative methods were curettage and bone grafting.The ratios of the total active range of motion (ROM) of the metacarpophalangeal joint and interphalangeal joint between ipsilateral and contralateral fingers were used to evaluate the ipsilateral fingers'function.The time of returning to work was recorded.The multiple linear regressions were performed to analyze the risk factors of the effectiveness. ResultsA total of 65 cases were followed up 5-44 months (mean,24 months).All incisions achieved primary healing.No infection,re-fracture,or recurrence occurred.The X-ray films showed fracture healing,the healing time was 5-10 weeks (mean,6.5 weeks).All the bone grafts healed well.At last follow-up,the ROM ratio of the fingers was 0.46-1.00(mean,0.90).The time of returning to work was 92-180 days (mean,130 days).Multiple linear regressions showed that internal fixation was risk factor for the ROM ratio of the fingers (P=0.013).The duration from fracture to operation,internal fixation,and the tumor site were risk factors for the time of returning to work (P<0.05). ConclusionTo obtain good effectiveness for patients with solitary enchondroma of the hand with pathologic fracture,it is suggested that immediate operative treatment including tumor curettage,open reduction,and internal fixation with plate and screws of the fracture.
ObjectiveTo evaluate the results of corticoplasty for multiple enchondromatosis of the hand. MethodsBetween February 2003 and January 2011, 6 patients with multiple enchondromatosis were treated. Of 6 cases, 1 was boy and 5 were girls with an average age of 10.8 years (range, 9-12 years); 5 cases presented with painless mass as first symptom, and 1 case was found to have mass by X-ray film because of hand injury. Physical examination at admission showed multiple mass on the hands, fingers deformity, and limited range of motion; X-ray film results showed large lesions in the phalanges and metacarpals. Corticoplasty and simple curettage without bone grafting were performed on 24 fingers (60 bones) with multiple enchondromatosis of the hand. The fingers active range of motion was used to evaluate the finger function; the diameter of the tumors was measured on the X-ray films; and according to Tordai's classification, tumor recurrence and new bone formation were observed. ResultsOnce, twice, or three-time operations were performed in 2 cases, respectively. All patients were followed up 17-83 months with an average of 52.2 months. At last follow-up, the active range of motion was significantly increased from (230.8±53.2)° at preoperation to (255.0±28.7)° at postoperation (t=—3.829, P=0.001); the tumor diameter was significantly decreased from (15.6±5.8) mm at preoperation to (10.7±3.7) mm at postoperation (t=8.304, P=0.000). Of 60 bones, 34 (56.7%) were rated as Tordai grade 1, and 26 (43.3%) as Tordai grade 2. During follow-up, clinical manifestation, characteristics of radiology and pathological examination showed no pathological fracture or malignant change. ConclusionCorticoplasty is a safe and effective treatment for multiple enchondromatosis of the hand in children. The procedure can improve appearance and motion function of the hand.
ObjectiveTo observe the characteristics of acetabular labrum injury in Pipkin fractures and the effectiveness of repairing the labrum with suture anchor. MethodsBetween July 2010 and July 2013, 10 cases of Pipkin fractures accompanied by acetabular labrum injury were treated. There were 7 males and 3 females with an average age of 32.5 years (range, 24-56 years). The causes of injury included traffic accident in 8 cases and falling from height in 2 cases. According to the Pipkin classification criteria, there were 6 cases of type Ⅱ, 2 cases of type Ⅲ, and 2 cases of type Ⅳ. The average interval from injury to operation was 8 days (range, 6-14 days). All the patients underwent open reduction and internal fixation through transtrochanteric approach with trochanteric osteotomy, and repair the labrum with suture anchor. The effectiveness was evaluated according to the Thompson & Epstein scoring scales after operation. ResultsAll incisions healed primarily without early complication of deep infection or deep vein thrombosis of lower limb. All the cases were followed up 22 months on average (range, 12-48 months). X-ray films showed that all osteotomies and acetabular fractures healed within 3-4 months, femoral head and femoral neck fracture healed within 6-11 months. MRI examinations showed that all repaired acetabular labrums well healed. One case had necrosis of the femoral head at 12 months after operation, and was treated by total hip arthroplasty. According to the Thompson & Epstein scoring scales at last follow-up, the results were excellent in 5 cases, good in 3 cases, fair in 1 case and poor in 1 case, with an excellent and good rate of 80%. ConclusionThe diagnosis of acetabular labrum injury can be easily missed during Pipkin fracture, preoperative diagnosis should be combined with hip MRI. Trochanteric osteotomy through transtrochanteric approach, and repairing the labrum with suture anchor can restore the hip function effectively.