ObjectiveTo explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook.MethodsFive patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness.ResultsAll the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] (t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] (t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case.ConclusionFor the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.
Objective To analyze the therapy and effectiveness of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury. Methods Between October 2005 and October 2012, 16 cases of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury were treated. There were 14 males and 2 females with an average age of 42 years (range, 22-58 years). Fracture was caused by traffic accident in 8 cases, by mechanical crush in 5 cases, and by falling in 3 cases. According to the anatomical features of the ulnar styloid and imaging findings, ulnar styloid fractures were classified as type I (ulnar styloid tip fracture) in 1 case and type II (ulnar styloid base fracture) in 15 cases. The skin sensation of ulnar wrist was S0 in 5 cases, S1 in 1 case, S2 in 7 cases, and S3 in 3 cases according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist. The time from injury to operation was 6-72 hours (mean, 18 hours). Fracture was treated by operative fixation, and nerve was repaired by epineurium neurolysis in 13 cases of nerve contusion and by sural nerve graft in 3 cases of complete nerve rupture. Results All incisions healed by first intention. Sixteen patients were followed up for an average time of 14 months (range, 6-24 months). The X-ray films showed that all of them achieved bone union at 4-10 weeks after operation (mean, 6 weeks). No patient had complications such as ulnar wrist chronic pain and an inability to rotate. According to Green-O’Brien wrist scoring system, the results were excellent in 13 cases and good in 3 cases; according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist, the results were excellent in all cases, including 11 cases of S4 and 5 cases of S3+. Two-point discrimination of the ulnar wrist was 5-9 mm (mean, 6.6 mm). Conclusion For patients with ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury, internal fixation and nerve repair should be performed. It can prevent ulnar wrist pain and promote sensory recovery.
ObjectiveTo explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. MethodsBetween May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm. ResultsTwo flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S4 in 33 and S3+ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S4 with no atrophy of the finger. ConclusionWith constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.
Objective To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist. Methods Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014. There were 8 males and 23 females with an age of 33-69 years (mean, 56.4 years). In palm lateral three and a half finger, the two-point discrimination was 7-14 mm (mean, 9.5 mm), in which 24 cases were 4-10 mm and 7 cases were more than 10 mm. Carpal tunnel median nerve Tinel sign was positive; there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points. Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases, more than 10 ms in 9 cases; fibrillation potentials and positive phase voltage happened in 6 cases; the median nerve sensory conduction velocity of all patients was slow, and the motor conduction velocity also slowed down; the motor amplitude was 5-10 mV in 19 cases, less than 5 mV in 12 cases. The disease duration was 3-8 months (mean, 5.5 months). Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients, especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon, fiber bundles at ulnar side of short hallux flexor tendon, deep layer fiber of the palmar aponeurosis, and variant shallow head of short hallux flexor. Results All the wounds healed by first intention without wound scar pain. The patients were followed up 24-59 months (mean, 33 months). Night numbness and pain disappeared, and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared. The sensation recovered to S4 in 28 patients in palm lateral three and a half finger, the index and middle fingertip sensation recovered to \begin{document}$ \small{{\rm{S}}_{{{ 3}^ + }}} $\end{document} in 3 cases. In the median nerve innervation area, the two points discrimination was 4-6 mm (mean, 4.8 mm). The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases. The grip strength of all the 31 cases recovered, and 1 of them increased significantly. In preoperative big thenar muscle atrophy cases, muscle strength recovered to S5 in 4 cases, S4 in 2 cases. At 2 years after operation, according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong, the results were excellent in 29 cases and good in 2 cases, with an excellent and good rate of 100%. Conclusion When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method, the variety entrapment factors of return branch of median nerve should be completely released, so the effectiveness can be improved.