ABSTRACT
<p><b>OBJECTIVE</b>To explore the similarity between the iliac crest and the metacarpal bone, so as to provide an anatomical basis for the reconstruction of the metacarpal bone of the hand with the iliac crest grafting.</p><p><b>METHODS</b>There are 16 upper limb specimens and 10 pelvic specimens. The morphological features of the second, third, fourth and 5th metacarpal bones and iliac crest were observed. The following indexes were measured: arc height and length of metacarpal head articular surface, volar-dorsal metacarpal diameter, ulnoradial diamater, arc height and length of iliac crest, and inner and outer diameter. The obtained data were statistically analyzed to compare the morphological, structural features, arc length and diameter length of each metacarpal bone and iliac crest.</p><p><b>RESULTS</b>The arc length of the second metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 22.040(21.425, 23.085) mm, (14.034±0.465) mm, 4.185 (4.113, 4.598) mm, and (12.227±0.414) mm respectively. The arc length of the third metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 23.430(22.743, 24.153)mm, (14.316±0.430) mm, 4.235(4.170, 4.670) mm, and (12.382±0.425) mm respectively. The arc length of the fourth metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 21.960 (21.245, 22.285) mm, (12.382±0.288) mm, 4.125 (4.030, 4.305) mm, and (11.991±0.362) mm respectively. The arc length of the fifth metacarpal head, volar-dorsal metacarpal diameter, arc height, and the ulnoradial diameter are 20.030 (19.668, 20.148) mm, (11.807±0.358) mm, 4.015(3.880, 4.205) mm, and (11.659±0.399) mm respectively. The inner and outer diameter of the iliac crest is 14.350 (13.660, 14.739) mm, and the arc length and height are (22.930±0.701) mm and (4.520±0.184) mm respectively. The difference between the volar-dorsal metacarpal diameter of the second metacarpal head and the inner and outer diameter of the iliac crest has no significant; while the volar-dorsal metacarpal diameter of the third, fourth and fifth metacarpal heads are apparently longer and shorter than the inner and outer diameter of the iliac crest, respectively. The differences are statistically significant. The differences between arc length of the iliac crest and arc length of the second, fourth and fifth metacarpl head are statistically significant. However, the difference of arc length between the third metacarpal head and the ilium, as well as the difference of arc height between the second and third metacarpal heads and the iliac crest have no statistical significances, while the arc height of the fourth and fifth metacarpal heads are obviously smaller than that of the iliac crest.</p><p><b>CONCLUSIONS</b>Autologous iliac crest is similar with metacarpal bone in anatomy, which might be a suitable donor for metacarpal bone transplantation.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint.</p><p><b>METHODS</b>From June 2012 to June 2014, totally 41 patients (45 fingers) with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K-wires fixation, and all the patients were followed up. In the dynamic external fixtor combined with limited internal fixation group (group A), there were 21 patients with 22 fingers, including 12 males and 9 females, with an average of (30.6±5.6) years old. In the cross K-wires fixation group (group B), there were 20 patients with 23 fingers, including 11 males and 9 females, with an average of (30.1±5.3) years old. Regular re-examination of X-ray was performed to evaluate the active range of joint motion, fracture healing time, infection rate and postoperative joint motion pain.</p><p><b>RESULTS</b>According to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association, the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences (Z=2.558, P=0.011). The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was (7.9±2.1) weeks, and (8.1±2.3) weeks for group B. There was no significant difference on the mean healing time (t=-0.304, P=0.762). The infection fingers of group A was 5, and 1 for group B. The difference between the results was statistically significant (χ2=3.287, P<0.05). The infection rate of group A was higher than that of group B. The postoperative joint motion pain was evaluated by VAS score, the mean score was 0.18±0.50 in group A, and 0.65±0.88 in group B. The difference between the results was statistically significant (t=-2.207, P<0.05). The postoperative joint motion pain was lower than that of group B.</p><p><b>CONCLUSION</b>Dynamic external fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.</p>