MINI EXTERNAL FIXATION DEVICE FOR COMMINUTED OPEN FRACTURES OF METACARPAL AND PHALANGE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Xin , SUN Luyuan , DAI Jiezhi , CHAI Yimin , ZHANG Changqing.

Department of Orthopedics, the Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, 200233, P.R.China. Corresponding author: ZHANG Changqing, E-mail: changqingzhang@yahoo.cn;

Corresponding author：

Keywords：

Mini external fixation device; Metacarpal and phalange; Open fracture; Comminuted fracture

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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.

Citation： MA Xin,SUN Luyuan,DAI Jiezhi,CHAI Yimin,ZHANG Changqing.. MINI EXTERNAL FIXATION DEVICE FOR COMMINUTED OPEN FRACTURES OF METACARPAL AND PHALANGE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 17-20. doi: Copy

1.	张功林, 葛宝丰. 外固定支架治疗骨折研究进展. 国际骨科学杂志, 2011, 32(2): 99-101.
2.	Drenth DJ, Klasen HJ. External fixation for phalangeal and metacarpal fractures, J Bone Joint Surg (Br), 1998, 80(2): 227-230.
3.	Alexander VA, Seitz WH. Current trends and uses of external fixation in the hand and carpus. Curr Opin Orthop, 1997, 8(IV): 1-6.
4.	宋飒, 张长青, 苏琰, 等. 应用弹力型可活动外固定器械治疗近侧指间关节骨折脱位. 中华创伤骨科杂志, 2005, 7(1): 36-38, 47.
5.	Kneser U, Goldberg E, Polykandriotis E, et al. Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations. Arch Orthop Trauma Surg, 2009, 129(1): 29-37.
6.	Li WJ, Tian W, Tian GL, et al. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation. Chin Med J (Engl), 2009, 122(21): 2616-2619.
7.	Walter FL, Papandrea RF. A mini external fixator for hand and finger fractures constructed from readily available materials. Tech Hand Up Extrem Surg, 2011, 15(4): 215-218.
8.	Ugwonali OF, Jupiter JB. Mini external fixation in the hand. Tech Hand Up Extrem Surg, 2006, 10(3): 187-196.
9.	Wegner D, Wolfe SW. Current concepts of fixation techniques in the hand. Curr Opin Orthop, 1994, 5(IV): 28-34.
10.	Nagy L. Static external fixation of finger fracture. Hand Clin, 1993, 9(4): 651-657.
11.	刘光军, 谭琪, 王成琪, 等. 单臂微型外固定架结合简易内固定治疗粉碎性掌指骨骨折. 中国骨与关节损伤杂志, 2012, 27(1): 70-71.
12.	金日浩, 王夫平, 冷树立. 微型外固定架结合有限内固定治疗38例46处开放性粉碎性掌指骨骨折分析. 重庆医学, 2009, 38(15): 1932-1933.
13.	Ng CY, Oliver CW. Fractures of the proximal interphalangeal joints of the fingers. J Bone Joint Surg (Br), 2009, 91(6): 705-712.
14.	田文, 田光磊, 陈山林, 等. 微型外固定架结合有限切开复位内固定治疗手部关节内骨折. 中华骨科杂志, 2009, 29(6): 563-566.
15.	Schuind F, El Kazzi W, Cermak K, et al. External fixation at the wrist and hand. Rev Med Brux, 2011, 32(6 Suppl): S71-75.
16.	Smith RS, Alonso J, Horowitz M. External fixation of open comminuted fractures of the proximal phalanx. Orthop Rev, 1987, 16(12): 937-941.

1. 张功林, 葛宝丰. 外固定支架治疗骨折研究进展. 国际骨科学杂志, 2011, 32(2): 99-101.
2. Drenth DJ, Klasen HJ. External fixation for phalangeal and metacarpal fractures, J Bone Joint Surg (Br), 1998, 80(2): 227-230.
3. Alexander VA, Seitz WH. Current trends and uses of external fixation in the hand and carpus. Curr Opin Orthop, 1997, 8(IV): 1-6.
4. 宋飒, 张长青, 苏琰, 等. 应用弹力型可活动外固定器械治疗近侧指间关节骨折脱位. 中华创伤骨科杂志, 2005, 7(1): 36-38, 47.
5. Kneser U, Goldberg E, Polykandriotis E, et al. Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations. Arch Orthop Trauma Surg, 2009, 129(1): 29-37.
6. Li WJ, Tian W, Tian GL, et al. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation. Chin Med J (Engl), 2009, 122(21): 2616-2619.
7. Walter FL, Papandrea RF. A mini external fixator for hand and finger fractures constructed from readily available materials. Tech Hand Up Extrem Surg, 2011, 15(4): 215-218.
8. Ugwonali OF, Jupiter JB. Mini external fixation in the hand. Tech Hand Up Extrem Surg, 2006, 10(3): 187-196.
9. Wegner D, Wolfe SW. Current concepts of fixation techniques in the hand. Curr Opin Orthop, 1994, 5(IV): 28-34.
10. Nagy L. Static external fixation of finger fracture. Hand Clin, 1993, 9(4): 651-657.
11. 刘光军, 谭琪, 王成琪, 等. 单臂微型外固定架结合简易内固定治疗粉碎性掌指骨骨折. 中国骨与关节损伤杂志, 2012, 27(1): 70-71.
12. 金日浩, 王夫平, 冷树立. 微型外固定架结合有限内固定治疗38例46处开放性粉碎性掌指骨骨折分析. 重庆医学, 2009, 38(15): 1932-1933.
13. Ng CY, Oliver CW. Fractures of the proximal interphalangeal joints of the fingers. J Bone Joint Surg (Br), 2009, 91(6): 705-712.
14. 田文, 田光磊, 陈山林, 等. 微型外固定架结合有限切开复位内固定治疗手部关节内骨折. 中华骨科杂志, 2009, 29(6): 563-566.
15. Schuind F, El Kazzi W, Cermak K, et al. External fixation at the wrist and hand. Rev Med Brux, 2011, 32(6 Suppl): S71-75.
16. Smith RS, Alonso J, Horowitz M. External fixation of open comminuted fractures of the proximal phalanx. Orthop Rev, 1987, 16(12): 937-941.

Chinese Journal of Reparative and Reconstructive Surgery

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

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