Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study / Fixação intramedular com parafusos de compressão versus técnica do buquê em fraturas instáveis do colo do metacarpo em pacientes ativos: Ensaio clínico randomizado

Abstract Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Resumo Objetivo Comparar a amplitude de movimento (ADM), o tempo de retorno de trabalho, a pontuação na escala visual analógica (EVA), o escore no questionário abreviado incapacidade do braço, ombro e mão (QuickDASH, na sigla em inglês) e os resultados radiográficos de dois métodos de fixação interna definitiva em pacientes ativos com fraturas do boxer; operados na primeira semana. Métodos Este foi um ensaio prospectivo randomizado, no qual 50 pacientes, com idade mediana na faixa de 18 a 40 anos, foram randomizados e tratados com fixação intramedular definitiva utilizando 2 parafusos de compressão (n = 20) ou buquê (2 ou 3 fios de Kirschner) (n = 20). Os pacientes foram avaliados em relação ao tempo de retorno ao trabalho, à ADM, ao desfecho relatado pelo paciente no questionário QuickDASH, à EVA e à avaliação radiográfica aos 6 meses. Resultados Aos 6 meses, não houve diferenças entre os 2 grupos em termos de ADM, dor pós-operatória (EVA) ou escore no QuickDASH. A taxa global de complicações foi de 4,76% no grupo de fixação com parafusos, em comparação com 5% no grupo de fixação com a técnica do buquê. Conclusões Parafusos de compressão e fixação com buquês provaram ser tratamentos seguros e confiáveis para pacientes ativos com fraturas instáveis. Os resultados foram semelhantes nos dois grupos.

Reconstruction of composite bone and soft tissue defect of the hand or foot with the chimeric medial femoral condyle osteofascial free flap / 中华显微外科杂志

Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.

Treatment of open metacarpal fractures with supercutaneous locking plate / 中华创伤骨科杂志

Objective To evaluate the supercutaneous fixation with locking plate for treatment of open metacarpal fractures.Methods From March 2015 to November 2016,16 open metacarpal fractures were treated with supercutaneous locking plate after emergency debridement at Department of Hand Surgery,The Second Affiliated Hospital to Wenzhou Medical University.They were 11 men and 5 women,from 20 to 67 years of age (average,37.5 years).There were 2 cases of the 1st metacarpal fracture,6 ones of the 2ed metacarpal fracture,one of the 3rd metacarpal fracture,2 ones of the 4th metacarpal fracture and 5 ones of the 5th metacarpal fracture.All fractures were open injury.By the Gustilo-Anderson classification,there were 9 cases of type Ⅱ and 7 ones of type Ⅲ A.Functional rehabilitation was encouraged immediately after operation.The outcomes were evaluated at the 4th and 24th weeks postoperatively according to the Total Angle of Motion (TAM) for digital joints recommended by the Hand Surgery Society,Chinese Medical Association.Results The mean operation time was 46.8 minutes (from 35 to 108 minutes).All cases were followed up for an average of 9.8 months (from 7 to 25 months).All fractures healed without breakage or loosening of the supercutaneous locking plate after an average of 6.2 weeks(from 4.3 to 7.8 weeks).Nail tract infection occurred in 3 cases.According to the TAM at the 4th week postoperatively,5 cases were rated as excellent,8 as good,2 as fair and one as poor;according to the TAM at the 24th week postoperatively,11 cases were rated as excellent,4 as good and one as fair.Conclusion For open metacarpal fractures with severe contamination or soft tissue injury,supercutaneous locking plate fixation can achieve fine clinical outcomes.

Manual reduction and traction fixation for the treatment of metacarpal neck fractures under ultrasound-guided / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical efficacy of manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided.</p><p><b>METHODS</b>From April 2013 to August 2016, 30 patients with metacarpal neck fractures were treated with manual reduction and traction fixation under ultrasound-guided, including 26 males and 4 females aged from 14 to 56 years old with an average of (25.6±1.6) years old, the courses of diseases ranged from 7 h to 5 d with an average of (2.7±0.6) d. Twenty patients were the fifth metacarpal neck fracture, 7 patients were the 4th and 5th metacarpal neck fractures, 3 patients were the second metacarpal neck fracture. Fracture healing, angle of bilateral head shaft angle and active range of metacarpophalangeal joints was measured, and DASH score was applied to evaluate function.</p><p><b>RESULTS</b>Twenty-seven patients were followed up from 6 to 11 months with an average of(7.2±0.8) months. Fracture were healed from 5 to 8 weeks with an average of (5.6±0.4) weeks. The affected shaft angle was (15.1±1.8)°, and health head shaft angle was (13.5±2.8)°, while there was no significant difference (=1.54, >0.05). The affected range motion of metacarpophalangealjoint was(86.3±2.6)°, health active range motion of metacarpophalangeal joint was(91.8±1.6)°, and no significant difference between both side (=1.16, >0.05). DASH score was 4.3±1.5 at 7 months after operation.</p><p><b>CONCLUSIONS</b>Manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided could dynamic observe fracture position in time, high patients' acceptability and is a feasible method for the treatment of metacarpal neck fracture.</p>

Hand Fractures

Hand fractures are the second most common fracture in the upper extremities after the distal radius, and patients with these injuries may be experienced in hand surgery clinics. On the other hand, during the treatment of hand fractures, complications can occur due to complex functions of the hand and small-sized injuries to the bone and soft tissues. This review focused on the principles of management of these fractures, including injury mechanism, evaluations and recent treatment options. Minimally invasive surgery in various types of hand fractures, including the phalanx and metacarpal bone, is preferred because early mobilization after surgery has been emphasized to reduce complications, such as stiffness.

Research progress in surgical procedures for fifth metacarpal neck facture / 中华创伤杂志

Clench beating or other direct violent action often leads to neck fracture combined with typical dorsal angulation deformity because of the special anatomical structure of the fifth metacarpal neck.There are various treatment methods for the fifth metacarpal neck fracture with their own advantages and disadvantages.Conservative treatment can achieve good fracture healing and has slight effect on function,yet often leaving appearance deformity.Kirschner wire fixations are varied and can obtain satisfactory results,but the drawbacks include obvious tendon adhesion and pin track infection.Microplate screw fixation can obtain good stability that allows early functional exercise.However,its disadvantages include scars,multiple surgeries,and higher medical expenses.External fixation has good curative effect on comminuted joint fracture.With the development of bioengineering technology,absorbable internal fixation is gradually applied to clinical treatment with satisfactory therapeutic effect,but its application is still limited due to the huge cost.Therefore,there is still no unified optimal therapeutic regimen.The author reviews the anatomical characteristics,fracture characteristics,treatment principles,and treatment methods so as to provide reference for formulation of clinical therapy.

Ultrasound-guided minimal invasive fixation for metacarpus and phalange fractures / 中国医学影像技术

Objective To explore value of high-frequency ultrasound-guided minimally invasive fixation treatment for metacarpus and phalange fractures.Methods Totally 26 patients of acute metacarpus and phalange fractures were selected and randomly divided into experimental group and control group (each n =13).The patients in experimental group underwent ultrasound-guided closed reduction,while in control group underwent C-arm X-ray fluoroscopy-guided reduction.Then the patients in two groups were followed up,and the curative effect of both methods were observed.Results The successful rate of closed reduction was 76.92％ (10/13) in experimental group,while was 84.62％ (11/13) in control group (x2=0,P=1.00).C-arm fluoroscopy was performed (0.62±1.19) times in experimental group,and (3.46±0.78) times in control group (t=-7.21,P＜0.01).The average healing time of fracture was (5.45±0.64) weeks in experimental group and (5.71±0.78) weeks in control group.The excellent and good rate of total active motion (TAM) was 84.62％ (11/13) in experimental group and 92.31％ (12/13) in control group,respectively.The average grip strength was (32.22±2.44) kg in experimental group,and (34.11±2.74) kg in control group (all P＞0.05).Conclusion High frequency ultrasound-guided minimally invasive fixation is reliable in treatment of metacarpal and phalangeal fractures,which can significantly reduce X-ray radiation.

Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

PURPOSE: Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results. METHODS: This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated. RESULTS: Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up. CONCLUSION: Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.

Clinical Study on Percutaneous Intramedullary Bioresorbable Pin Fixation for Fourth and Fifth Metacarpal Bone Fracture

PURPOSE: Metacarpal fracture of a ring and little finger occurs frequently. Percutaneous intramedullary fixation is a simple and effective method with a low incidence of complications. To date, Kirschner wire (K-wire) fixation has been widely used, but this has problems such as pin infection. Moreover it is difficult to start early active motion exercise. So, we replaced the K-wire with a bioresorbable implant and evaluated the results. METHODS: This study was conducted from 2014 to 2016 and involved 10 consecutive patients with 10 metacarpal neck fractures. All cases underwent percutaneous intramedullary fixation using the ActivaPin (Bioretec Ltd.) within 7 days after injury, and the average follow-up period was 13 months. At the final follow-up, all cases were assessed in terms of total active motion (TAM), bony union and angular deformity based on plain radiographs. RESULTS: The patients started active motion exercise within 1 week and regained a full range of motion after average 4 weeks. The TAM results were excellent at 250° to 270° in all cases. Regarding radiographic findings, fractures united in all cases and there were no malunion and knuckle deformity. CONCLUSION: Replacement of a K-wire with a bioresorbable pin prevented soft tissue damage and dorsal scarring. And our percutaneous intramedullary bioresorbable pin fixation technique resulted in early recovery of range of motion and correction of deformity. The patients regained range of motion and returned to daily life early.

Tratamiento de las fracturas no articulares de los metacarpianos excluido el primer dedo. Revisión bibliográfica sistematizada / Treatment of non-articular metacarpal fractures excluding thumb

Las fracturas de los metacarpianos constituyen el 10% del total de las fracturas(¹) y representan un 30%-50% de las fracturas de la mano(²). La fractura del cuello del quinto metacarpiano es la más frecuente, también llamada Boxer fracture, corresponde al 20% de todas las fracturas de la mano. Para la gran mayoría de estas fracturas la literatura actual avala el tratamiento conservador, ya que son estables desde el principio o luego de una reducción cerrada(¹). Se calcula que apenas un 5% tienen indicación quirúrgica. El propósito de nuestra revisión bibliográfica fue establecer los diferentes criterios que se utilizan para tratar en forma quirúrgica o no las fracturas no articulares de los metacarpianos excluido el primer dedo. Para ello realizamos una revisión sistematizada de los últimos diez años en mayores de 18 años, obteniendo 19 artículos que cumplían con nuestros criterios de inclusión. Nuestra estrategia de análisis fue revisar las indicaciones terapéuticas, frecuencia y justificaciones. Esta revisión sistematizada se organiza en tres grupos de trabajos, aquellos que se ocupaban del tratamiento ortopédico, los que indicaban el tratamiento quirúrgico y los que comparaban los resultados de ambos tratamientos entre sí. De sus resultados se puede concluir que no existe una indicación quirúrgica universalmente recomendada, ya que la literatura carece de estudios con nivel de evidencia I o II que vayan en esa dirección. De nuestra revisión se extrae cuáles son las indicaciones quirúrgicas más frecuentemente aceptadas en la literatura. Destacándose la angulación dorsal mayor a 30 grados, la malrotación y el acortamiento, los cuales determinan secuelas graves como el crossfinger, la pérdida de extensión o de fuerza de prensión. Finalmente, al no existir un consenso y hasta no contar con la suficiente evidencia científica, la decisión de la estrategia terapéutica recae sobre el cirujano ortopedista, quien debe elegirla según su experiencia, teniendo en cuenta la personalidad de la fractura, los materiales disponibles y la literatura revisada que lo avale.

Abstract Metacarpal fractures constitute 10% of the total number of fractures(1) and they represent 30%-50% of hand fractures(2). Fracture of the fifth metacarpal neck is the most frequent one, also called Boxer fracture, corresponding to 20% of all hand fractures. Literature favors a conservative treatment for most of these fractures, since they are stable from the beginning or after a closed reduction. Our bibliographic review aims to define the different criteria used to treat extra-articular metacarpal fractures excluding the thumb, with or without surgery. To that end, we conducted a systematized review of the last 10 years in patients over 18 years old, obtaining 19 articles that met our inclusion criteria. Our analysis strategy was to review therapy indications, frequency and justification. Systematized revision was divided into three groups of work: those who dealt with orthopedic treatment, those who indicated surgical treatment and those who compared results between the two treatments. Results led to the conclusion that there is no surgical indication that is universally recommended, since literature lacks Level I or II studies on this matter. Our review reveals the most frequently accepted surgical indications in literature. Dorsal angulation exceeding 30 degrees, malrotation and shortening stand out, all of which result in severe sequelae such as crossfinger, loss of extension or grip strength. Last, there being no consensus and until there is enough scientific evidence, decisions on therapeutic strategies are to the orthopedic surgeon, which decision shall be based on their experience, considering the kind of fracture, materials available and reviewed literature that supports it.

Resumo As fraturas dos metacarpianos correspondem a 10% das fraturas em geral(1) e a 30%-50% das fraturas da mão(2). A fratura do colo do quinto metacarpiano, também conhecida como Boxer fracture, é a mais frequente - 20% das fraturas da mão. A literatura atual apoia o tratamento conservador para a grande maioria destas fraturas, pois são estáveis desde o começo ou depois de uma redução fechada(1). Calcula-se que apenas 5% tem indicação cirúrgica. O objetivo desta revisão bibliográfica foi identificar os diferentes critérios utilizados para tratar, cirurgicamente ou não, as fraturas não articulares dos metacarpianos excluindo o primeiro dedo. Realizamos una revisão sistemática da literatura científica dos últimos dez anos que incluíam pacientes maiores de 18 anos; 19 artigos foram selecionados por seguir os critérios de inclusão. A estratégia da análise foi revisar as indicações terapêuticas, frequência e justificativas. Os artigos foram organizados em três grupos: tratamento ortopédico, tratamento cirúrgico e os que comparavam os resultados de ambos os tratamentos. A análise dos resultados mostrou que não se pode concluir que exista una indicação cirúrgica universalmente recomendada, pois a literatura carece de estudos com níveis de evidencia I ou II que considerem esses aspectos. Entre as indicações cirúrgicas mais frequentemente aceitas na literatura se destacam a angulação dorsal maior a 30 graus, má rotação e encurtamento, que determinam sequelas graves como o crossfinger, a perda da extensão ou da força de preensão. Finalmente, como não existe um consenso e enquanto não houver suficiente evidencia científica, a decisão sobre a estratégia terapêutica cabe ao ortopedista, que deve basear-se em sua experiência, considerando as características da fratura, os materiais disponíveis e a literatura disponível.

The Efficacy of Transverse Fixation and Early Exercise in the Treatment of Fourth Metacarpal Bone Fractures

BACKGROUND: Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture. METHODS: A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated. RESULTS: Dorsal angulation improved from a preoperative value of 44.2° to a postoperative value of 5.9°. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed. CONCLUSIONS: We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization.

Osteosarcoma of the Metacarpal Bone / 대한정형외과학회잡지

Osteosarcoma commonly develops around the knee joint, and rarely in the hand. Patients with osteosarcoma of the hand often present with pain and swelling, and osteosarcoma of the hand has a biological behavior that differs from that of osteosarcoma at conventional sites. However, although it usually occurs in the older age group, compared with conventional osteosarcoma, the most common sites of hand osteosarcoma correlate with the most active growth and longest growing bones in the hand like conventional osteosarcoma, particularly in the metacarpophalangeal joints in the second and third digits. However, development of osteosarcoma in the metacarpal bone of the hand in an elderly patient has not yet been reported in the country. Thus, we report on two cases of osteosarcoma in the metacarpal bone of the hand in elderly patients, treated by ray amputation of the digit and preoperative and postoperative chemotherapy.

X-ray measurement of metacarpal bones of right hand in children aged 7-12 in Kaschin-Beck disease endemic areas in Xinghai County, Qinghai Province / 中华地方病学杂志

Objective Though X-ray measurement of metacarpal bones of right hand in children aged 7-12 in Kaschin-Beck disease (KBD) endemic areas in Xinghai County,Qinghai Province,to provide scientific basis for KBD diagnosis and research on growth and development of children in KBD endemic areas.Methods In 2012,277 children aged 7-12 were carried out clinical examination and right hand X-ray photos in KBD endemic areas,Xinghai County,Qinghai Province.Metacarpal bones were measured by electronic digital vernier caliper,and the axis length and width of the metacarpal bones and its metacarpal bone index were calculated.All data were analyzed by SPSS 19.0 software.Results The axis lengths of the metacarpal bones were in an order of 2.metacarpal ＞ 3.metacarpal ＞ 4.metacarpal ＞ 5.metacarpal ＞ 1.metacarpal in 6 different age groups and different genders; the width of 1.metacarpal bone was the widest; the width of 4.metacarpal bone was the smallest,and the rest of metacarpal bones were similar.The metacarpal bone indexes of female [(7.96 ± 0.76),(8.24 ± 0.92),(8.24 ± 0.71),(8.26 ± 0.92),(8.60 ± 1.02),(8.67 ± 0.84)mm] were higher than those of male's[(7.30 ± 0.78),(7.53 ± 0.77),(7.98 ± 0.90),(7.79 ± 0.56),(7.96 ± 0.64),(8.17 ± 0.92)mm,F =4.302,P ＜ 0.05].Conclusion The axis length,width and index of metacarpal bones of right hand in children between KBD endemic areas and no-KBD endemic areas are similar.

Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone

BACKGROUND: To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone. METHODS: A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire. RESULTS: During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group. CONCLUSIONS: Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

Características biométricas de los huesos metacarpianos en individuos chilenos / Biometric characteristics of the metacarpal bones in chilean individuals

Los huesos metacarpianos son largos y cilíndricos, articulándose proximalmente con el carpo y distalmente con las falanges proximales de los dedos. Estos huesos han recibido especial atención en el área de la medicina forense para la determinación del sexo. Con el objetivo de aportar datos biométricos sobre los huesos metacarpianos en individuos chilenos, determinamos radiográficamente, en 52 manos de individuos de ambos sexos, la longitud de cada uno de ellos, el ancho de su base, cuerpo y cabeza. En los individuos de sexo masculino, la longitud promedio del I metacarpiano fue de 40,9 +/- 6,4 mm y la del II metacarpiano de 60,8 +/- 7,4 mm; en el sexo femenino el I metacarpiano tuvo un promedio de 39,2 +/- 5,2 mm y el II metacarpiano de 60,6 +/- 8,9 mm. El ancho promedio de la epífisis proximal de cada hueso metacarpiano en individuos de sexo masculino fue para el I metacarpiano 12,5 ± 2,1 mm y para el II metacarpiano 14,8 ± 2,1 mm; en el sexo femenino, el I metacarpiano tuvo 11,6 ± 2,3 mm y el II metacarpiano 13,9 ± 2,1 mm. El diámetro promedio en la parte media del cuerpo de cada hueso en individuos masculinos fue para el I metacarpiano 11,8 +/- 2,2 mm y para el II metacarpiano 11,7 +/- 2,2 mm; en el sexo femenino, el I metacarpiano tuvo 10,86 +/- 2,8 mm y el II metacarpiano 11,8 +/- 2,6 mm. El ancho promedio de la epífisis distal de cada hueso en los individuos de sexo masculino fue para el I metacarpiano 6,7 +/- 1,2 mm y el II metacarpiano de 5,7 +/- 1,2 mm; en el sexo femenino, esta variable fue para el I metacarpiano 6,2 +/- 1,5 mm y para el II metacarpiano de 5,0 +/- 1,4 mm. El primer metacarpiano es el más corto de todos. El segundo metacarpiano siempre tuvo una longitud mayor que los otros metacarpianos, especialmente del tercero, que le sigue en longitud. En solo un caso la longitud del segundo metacarpiano fue menor que la del tercero y en dos casos el segundo y el tercer metacarpiano tuvieron la misma medida...

The metacarpal bones are long and cylindrical and articulate proximally and distally with carpus and with the proximal phalanges of the fingers, respectively. These bones have received special attention in the area of ??forensic medicine for sex determination. In order to provide biometric data on the metacarpal bones in Chilean individuals group, we determined radiographically in 52 hands, of both sexes, the length of each, the width of the base, body and head. In male subjects, the length averages were in the first metacarpal bone 40.9 +/- 6.4 mm and in the second metacarpal bone 60.8 +/- 7.4 mm, in females the first metacarpal bone had an average of 39.2 +/- 5.2 mm and second metacarpal 60.6 +/- 8.9 mm. The width averages of the proximal epiphysis of metacarpal bones in male individuals were in first metacarpal 12.5 +/- 2.1 mm and in second metacarpal 14.8 +/- 2.1 mm; in females, in the first metacarpal was 11.6 +/- 2.3 mm and 13.9 +/- 2.1 mm in second metacarpal bone. The diameter averages in the middle of the body in male individuals were 11.8 +/- 2.2 mm in first metacarpal bone and in second metacarpal, 11.7 +/- 2.2 mm; in females, the first metacarpal had 10.86 +/- 2.8 mm and the second metacarpal bone, 11.8 +/- 2.6 mm. The width averages of the distal epiphysis in male individuals were 6.7 +/- 1.2 mm in first metacarpal bone and in second metacarpal, 5.7 +/- 1.2 mm; in females, this variable was 6.2 +/- 1.5 mm in the first metacarpal bone and in the second metacarpal bone was 5.0 +/- 1.4 mm. The first metacarpal bone was the shortest of metacarpals. The second metacarpal always had a greater length than the other metacarpals, especially the third, next in length. In one case only the second metacarpal length was less than the third and in two cases the second and third metacarpal had the same length...

Correction of Congenital Metacarpal Synostosis with Polypropylene Mesh as an Interpositional Material / 대한정형외과학회잡지

Metacarpal synostosis is an uncommon congenital hand malformation characterized by the coalescence of two or more adjacent metacarpals. Patients visit the hospital due to abduction deformity, which is usually a mild deformity or a minor functional deficit. This is one of the reasons why the patient goes to the hospital late and foregoes proper management with early detection and treatment. A number of surgical procedures ranging from simple to complex have been employed for treatment of this deformity. We describe our experience with a longitudinal osteotomy, realignment of component metacarpals with the metacarpophalangeal joint, and interposition of a non-absorbable polypropylene mesh used for inguinal hernia for correction of the abducted deformity and prevention of recurrence of synostosis while minimizing morbidity.

X-ray measurement of metacarpal and phalange bones in the right hand of adult patients with Kaschin-Beck disease in Qinghai Province / 中国地方病学杂志

Objective By X-ray measurement of metacarpal and phalange bones in the right hand of adult patients with Kaschin-Beck disease in Qinghai Province,to provide anatomic data and information for clinic diagnosis of the disease and application of hand surgery.Methods Fifty-four cases of adult patients with Kaschin-Beck disease,who came from Guide County and Xinghai County in Hainan Prefecture,Qinghai Province,were selected as investigation subjects,then their right hand X-ray film were taken,metacarpal and phalange bones were measured by electronic digital vernier caliper.All data were analyzed with SPSS 19.0.Results The axis length of the metacarpal bones was in the order of:the 2nd metacarpal ＞ 3rd metacarpal ＞ 4th metacarpal ＞ 5th metacarpal ＞ first metacarpal.The axis length of proximal phalange bones was in the order of:the middle finger proximal ＞ ring finger proximal ＞ index finger proximal ＞ little finger proximal ＞ proximal thumb,while the middle,distal phalanx axis length varied greatly.The length of metacarpal and phalange bones of all male was longer than that of female(all P ＜ 0.01).The width of the metacarpal bones was in the order of:the 2nd metacarpal ＞ 3rd metacarpal ＞ 5th metacarpal ＞ 4th metacarpal.The width of the 2nd-5th metacarpal of male and female was (8.57 ± 0.90),(8.25 ± 0.80),(6.84 ± 0.69),(7.70 ± 0.77)mm and (7.40 ± 0.74),(7.36 ± 0.70),(6.00 ± 0.57),(6.62 ± 0.65)mm,respectively,the differences were significant(t =5.24,4.32,4.85,5.55,all P ＜ 0.01).The matacarpal bone index of female[(8.23 ± 0.90)mm] was significantly larger than that of male[(7.61 ± 0.76)mm,t =2.73,P ＜ 0.01].Conclusion X-ray measurement of hand may provide reference information for diagnosis of Kaschin-Beck disease and determination of metacarpal and phalange length in hand surgery.

Avascular Necrosis of the Head of the Third Metacarpal Bone / 대한정형외과학회잡지

Avascular necrosis of the metacarpal head named as 'Dieterich disease' is a very rare condition. Because of the lack of information about the natural course and treatment of this disease, the ideal treatment has not been established as yet. We report a case of avascular necrosis that occurred at the 3rd metacarpal head after fractures of the 4th and 5th metacarpal base; this was treated conservatively and obtained the spontaneous resolution.

Clinicopathologic characteristics and surgical treatment of obsolete Bennett fractures / 中华创伤骨科杂志

Objective To investigate clinicopathologic characteristics of obsolete Bennett fractures and their surgical treatment and prognosis. Methods From August 2008 to April 2010,13 patients with obsolete Bennett fracture were admitted to our department.They were 12 men and one woman,with an average age of 34.3 years (from 17 to 42 years).They had a fracture history of over 4 weeks to as long as 12 weeks (average,7.9 weeks).In all patients,after X-ray examinations,the radio-dorsal ligament complex of the first carpometacarpal joint was properly released,fracture gaps were cleared up,fracture fragments were anatomically reduced and fixed with a Kirschner wire,and at last the first metacarpal joint was fixed with the Kirschner wire crossing the joint Postoperatively all patients were immobilized with cast plaster for 4 weeks before the Kirschner wires acrross the joint were removed.Gradual rehabilitation was conducted.The X-rays were taken every month. Results The patients were followed for 6 to 24 months(average,14 months).The fractures healed in all the patients,with an average healing time of 3 months.No dislocation of the joints occurred.Injury to articular cartilage of the trapezium bone occurred in one patient,and no apparent pain was experienced in the other 12 patients.According to the Total Active Motion assessment,the thumb function was rated as excellent in 9 cases,good in 2,moderate in one and poor in one,with a good to excellent rate of 84.6％.Conclusions In obsolete Bennett fractures,the radio-dorsal ligament complex of the first carpometacarpal joint will have cicatricial contracture,preventing reduction of the fragments of the radio-dorsal joint.Therefore it is important to properly release the radio-dorsal ligament complex to achieve anatomical reduction of the radio-dorsal joint.An injury history of over 3 months and complicated injury to the trapezium bone cartilage may be significant factors affecting the prognosis of obsolete Bennett factures.

The Usefulness of Measuring the Second Metacarpal Length as a Predictive Index for Growth Velocity during GnRH Agonist Treatment in Girls with Central Precocious Puberty

PURPOSE: The growth velocity in patients with central precocious puberty during treatment cannot be predicted. There is a positive correlation in growth among the long bones of the body and the length of the femur and tibia may determine individual height. We want to determine whether the second metacarpal bone can be used as a predictive index for growth velocity during gonadotropin-releasing hormone (GnRH) agonist treatment. METHODS: Thirty-four female children who were diagnosed with precocious puberty at our clinic and treated with GnRH agonist for about 1 year were included in this study. Patients who had growth-related disease, such as growth hormone deficiency and thyroid diseases were excluded. We reviewed their medical records retrospectively. We measured their height and the second metacarpal length from the X-ray film (left hand Anterior-Posterior at the time of their diagnosis and about a year after their GnRH agonist treatment. RESULTS: The age of the subjects was 8.5+/-0.6 years. The growth velocity during treatment was 4.9+/-1.2 cm/yr. There was a positive correlation between height and the second metacarpal length at diagnosis (P = 0.000, r = 0.666) and at one year after treatment (P = 0.000, r = 0.654). There was no correlation between the second metacarpal length at diagnosis and growth velocity during treatment for 1 year. CONCLUSION: We could not find the correlation between the second metacarpal length and growth velocity during GnRH agonist treatment for 1 year. However, the second metacarpal length showed a positive correlation with height before and after treatment. Therefore further study should be done to discovering the mechanisms working during GnRH agonist treatment including bone age, midparental height and so on.