ObjectiveTo analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.MethodsThe clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.ResultsThe operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value (t=−20.02, P=0.00); and there was no significant difference (t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference (t=−1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.ConclusionThe effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
OBJECTIVE: To investigate the anatomic basis for transposition of the distal dorsal ulna bone flap pedicled with dorsal metacarpal artery to repair the defect of the 3rd or 4th and 5th metacarpal bone head. METHODS: In 30 adult cadaveric upper limbs, the branches and constitutions of the dorsal carpal arterial networks were observed. RESULTS: The dorsal carpal arterial networks were consisted of the dorsal carpal branches of ulnar and radial arteries, the terminal branches of posterior interosseous artery and the dorsal carpal branch of anterior interosseous artery, and then the 2nd, 3rd, 4th dorsal metacarpal branches were originated from the networks. The dorsal metacarpal branches were anastomosed with the deep branches of deep palmar arch to constitute the dorsal metacarpal artery. CONCLUSION: Transposition of the distal dorsal ulna bone flap pedicled with the 3rd, 4th dorsal metacarpal arteries can be used in repairing the defect of 3rd, 4th and 5th metacarpal bone head.
Objective To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.
ObjectiveTo investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. MethodsBetween February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. ResultsThe distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. ConclusionThe double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.
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.
ObjectiveTo investigate the effectiveness of Ilizarov technique in reconstruction of thumb function in patients with thumb degloving injury after amputation.MethodsBetween June 2011 and September 2016, 9 cases of thumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with an age of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, the level of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (the length of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy finger by 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender was applied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours.ResultsAfter bone lengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with the amputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recovered well; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months. Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with an average of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time of external fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an average of 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healing was finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. No replantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip was similar to that of normal fingertip. The grip strength reached 53%-89% of the healthy side; the kneading force reached 59%-91% of the healthy side.ConclusionThe application of Ilizarov technology to extend the thumb metacarpal lengthening is a good method to reconstruction the thumb function after degloving injury.