Objective To study the composition, distribution, and influencing factors of acute hand injuries in daily l ife in the Beijing area by analyzing the cl inical data from patients with acute hand injuries. Methods Between April 1st 2005 to September 30th 2005, 2 575 patients with acute hand injuries in daily l ife from Beijing area were investigated by questionnaire.The epidemiological factors were analyzed, including gender, age, injury time, injury cause, accident place, injury mechanism, and location. Results The 2 575 patients injuried in daily l ife accounted for 49.2% of all. Most of them were young males, and the male to female ratio was 3.3 ∶ 1. Most of the patients were 21-30 years old. The most common accident place was resting place (43.3%), and next was outdoors (28.8%) and leisure place (20.0%). Accidental injury was the major injury cause, accounted for 51.0%, followed by injury after drinking (16.1%) and violence (15.5%). The major injury mechanism was cutting (52.23%), followed by coll ision (16.04%) and fall ing (15.18%). A total of 2 405 patients were right hander, and handedness affected the distribution of injured hands significantly. Open injuries accouonted for 70.7% of the patients, and the tissues in deep layer were involved in the injury in 54.4% of all. Conclusion Hand injury in daily l ife is a common problem, which has its own epidemiological features. More appropriate measures should be taken to decrease the incidence.
Objective To evaluate the function of the reconstructed thumbs and the donor feet after thumb reconstructions with modified wrap-around flap. Methods A total of 65 patients who accepted thumb reconstruction with the modified wrap-around flap between January 2003 and October 2007 were followed up, including 54 males and 11 females with an average age of 33 years (range 15-46 years). There were 12 cases of skin degloving injury and late class I B defect, 44 cases of class II defect and 9 cases of class III A defect. The reconstructed thumbs and donor feet were examined andevaluated. Foot function index-verbal rating scales (FFI-5pt), American Orthopaedic Foot and Ankle Society (AOFAS) forhallux metatarsophalangeal-interphalangeal score, gait analysis and dynamic pedobarography were conducted to 20 patients who were followed up recently. Results Sixty-five patients were followed up 6-60 months with an average of 22 months. The reconstructed thumbs had aesthetic appearance and satisfactory range of motion. The two-point discrimination was (9.7 ± 2.8) mm, showing statistically significant difference (P lt; 0.05) when compared with that of the contralateral normal thumb [(4.2 ± 1.1) mm]. Full or most length of the donor toes were preserved in 63 patients. The width of remaining plantar strip skin that covered the plantar weight-bearing area was (24.5 ± 3.7) mm, and its two-point discrimination was (9.0 ± 2.6) mm; showing no statistically significant difference (P gt; 0.05) when compared with that of contralateral normal one [(8.1 ± 1.9) mm]. Of the 20 patients who were followed up recently, the evaluation of the FFI-5pt score showed that the pain scale score was 5.6 ± 4.5, the disabil ity scale score was 1.2 ± 2.7, and the FFI-5pt total scale score was 3.2 ± 2.9. The results of AOFAS cl inical rating scale showed that the pain scale score was 34.0 ± 5.0, the function scale score was 38.7 ± 4.2, the al igment scale score was 15.0 ± 0, and the total AOFAS scale score was 87.7 ± 7.4. There was no statistically significant difference (P gt; 0.05) in the durations of subphases of the gait cycle between the donor foot and the contralateral normal foot, and in the peak force and force-time integral of the two whole foot. The peak force of the donor toe was significantly smaller than that of the contralateral normal toe (P lt; 0.05), but there was no significant difference in the peak pressure (P gt; 0.05); and there were no significant differences in the peak forcesand peak pressures of other six anatomical sites of the two feet (P gt; 0.05). Conclusion Using the modified wrap-around flap for thumb reconstruction, aesthetic and functional thumbs can be obtained, and most of the function of the donor feet can be preserved.
Objective To investigate the application and effectiveness of metatarsal mortise and tenon shortening osteotomy in the treatment of macrodactyly in children. Methods The clinical data of 17 children with macrodactyly (18 feet and 27 toes) admitted between January 2018 and January 2020 were retrospectively analyzed. There were 12 males (12 feet and 18 toes) and 5 females (6 feet and 9 toes); the age ranged from 1 to 13 years, with a median age of 5 years. All children were treated with metatarsal mortise and tenon shortening osteotomy. Ten cases of single-segment metatarsals were shortened, 7 cases of 2-segment metatarsals, and 1 case of 3-segment metatarsals; involved 1 foot of single toe, 9 feet of 2 toes, 3 feet of 3 toes, 3 feet of 4 toes, and 2 feet of 5 toes. Five cases had lameness, and 1 case had limited walking with the big toes of both feet, and there was no obvious pain in all children. X-ray films showed that the involved phalanges were thickened and increased in 18 feet, and the deformity of the distal segment was heavier than that of the proximal segment in 13 feet, and the two were similar in 5 feet. The length of metatarsal shortening was 0.7-2.5 cm, with an average of 1.2 cm. The clinical healing of shortened metatarsal fractures in children was observed after operation, and the occurrence of related complications was recorded. ResultsAll 17 children were followed up 6-22 months, with an average of 14 months. All incisions healed by first intention. The osteotomy ends of 27 toes were clinically healed after operation, and the healing time was 4-8 weeks. No nonunion, fracture displacement, malunion, epiphyseal plate premature closure, and needle tract infection occurred. ConclusionMetatarsal mortise and tenon shortening osteotomy is a good osteotomy method. It can improve the stability of the osteotomy end and increase the contact surface of the osteotomy end, which is conducive to the healing of the osteotomy end and is suitable for the treatment of macrodactyly.