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 investigate the cl inical characteristics, diagnosis, and treatment of metacarpophalangeal (MCP) joint locking with extension lag. MethodsBetween February 2009 and April 2014, 17 patients (17 fingers) with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years (range, 20-72 years). The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion (ROM) of the MCP joint was (41.2±5.1)°. The visual analogue scale (VAS) score was 2.7±0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed. ResultsSuccessful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average (range, 6 months to 5 years and 2 months). The ROM of the MCP joint was increased to (80.4±6.6)° at last follow-up, showing significant difference when compared with ROM before reduction (t=-19.46, P=0.00). The VAS score decreased to 0.2±0.4 at last follow-up, also showing significant difference when compared with score before reduction (t=13.44, P=0.00). ConclusionAccessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.