Efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture.@*METHODS@#Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups.@*RESULTS@#No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05).@*CONCLUSION@#Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.

Tratamiento de fracturas de falanges y metacarpianos con tornillos endomedulares compresivos / Treatment of phalangeal and metacarpal fractures with intramedullary compression screws

Objetivos: Evaluar los resultados clínicos y radiográficos de pacientes con fracturas extrarticulares de falanges y metacarpianos de la mano, tratados mediante osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados.materiales y métodos: Estudio prospectivo que incluyó a pacientes >18 años con fracturas cerradas transversales u oblicuas cortas, ex-trarticulares, de falanges y metacarpianos tratadas entre noviembre de 2016 y junio de 2019. La serie estaba integrada por 47 pacientes, con 76 fracturas (28 de metacarpianos, 27 de falange proximal y 21 de falange media). Se evaluaron los resultados clínicos y funcionales con goniometría, registrando el rango de movilidad activa total. La evaluación radiográfica se realizó sobre la base de los criterios establecidos por Pun y cols. Todos los pacientes completaron el cuestionario QuickDASH en el examen final. Resultados: El tiempo promedio de seguimiento fue de 24.5 meses. El rango de movilidad activa total promedio fue de 238° para todas las fracturas, 252° para las de metacarpianos y 230° para las de falanges. Se observó la consolidación radiográfica de todas las fracturas. El tiempo promedio de retorno a la actividad habitual fue de 79 días. El resultado final del cuestionario QuickDASH fue 4,5. No hubo complicaciones ni cirugías secundarias. Conclusiones: La osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados resultó una alternativa eficaz para el tratamiento de fracturas extrarticulares de falanges y metacarpianos. Nivel de Evidencia: II

Objective: To study the clinical and radiological outcomes of patients with extra-articular phalangeal and metacarpal fractures who were treated with minimally invasive internal fixation using retrograde intramedullary compression screws.materials and me-thods: Prospective study in patients over 18 years of age treated for simple, transverse or short oblique, extra-articular phalangeal and metacarpal fractures between November 2016 and June 2019. The series included 47 patients and 76 fractures: 28 metacar-pal bones (MC), 27 proximal phalanges (PP), 21 middle phalanges (MP). Clinical and functional outcomes were assessed with goniometry, documenting the total active range of motion (TAM). Radiological outcomes were assessed using the criteria proposed by Pun et al. All patients completed the Quick DASH questionnaire at last follow-up. Results: The average follow-up period was 24.5 months. All study fractures average TAM was 238°, metacarpal TAM was 252°, and phalangeal TAM was 230°. Radiograph evaluation showed fracture consolidation in all cases. Average time taken to return to normal daily activities was 79 days. Average final Quick DASH score was 4.5. There were no complications nor secondary surgeries. Conclusions: Minimally invasive internal fixation with retrograde intramedullary compression screw proved to be a highly effective option in the treatment of extra-articular phalangeal and metacarpal fractures. Level of Evidence: II

Osteosíntesis mínimamente invasiva con tornillos centromedulares canulados para fracturas de metacarpianos / Minimal invasive osteosynthesis with cannulated screws in metacarpal fractures

Resumen: Antecedentes: Las fracturas de los metacarpianos comprenden de 18 a 44% de las fracturas de la mano. La mayoría de las fracturas simples de cuello y transversales diafisiarias de metacarpianos pueden ser tratadas de manera conservadora con buenos resultados. Sin embargo, en el caso de fracturas inestables no existe un estándar de oro para la osteosíntesis y ningún método ha mostrado hasta la fecha superioridad sobre los demás. Recientemente ha habido publicaciones sobre osteosíntesis con tornillos canulados centromedulares sin cabeza retrógrados con buenos resultados funcionales en fracturas de cuello y transversales diafisiarias de metacarpianos. Material y métodos: Series de casos con seguimiento a corto plazo tratados con osteosíntesis retrógrada con tornillos canulados sin cabeza en nueve fracturas de cuello de quinto metacarpiano, una de cuello de cuarto metacarpiano y una transversal diafisiaria de quinto metacarpiano. Resultados: Todos los pacientes lograron consolidación radiográfica y al mes de seguimiento tenían arcos de movimiento completos y realizaban actividades habituales. Una paciente con mano traumática y fractura de quinto metacarpiano presentó limitación de arcos de movimiento. En un caso con hueso osteoporótico y conminución de cortical volar no logramos evitar la pérdida de altura con tornillos, por lo que utilizamos clavillos Kirschner. Conclusión: La osteosíntesis mínimamente invasiva con tornillos canulados retrógrados sin cabeza es una buena opción para el tratamiento de fracturas transversales de diáfisis y de cuello de metacarpianos inestables porque es mínimamente invasiva y permite movilización y regreso temprano a actividades habituales.

Abstract: Metacarpal fractures comprise 18 to 44% of hand fractures. Fractures from the second to the fifth metacarpals are 88% of the metacarpal fractures and fractures of the fifth metacarpals are the most common. Fractures of the neck of the fifth metacarpal are about 20% of all the hand fractures. Most of these fractures can be treated conservatively with good functional results. However, for those neck and shaft unstable fractures that need surgical treatment, there is no gold standard for osteosynthesis. Recently, there have been reports of minimally invasive osteosynthesis using headless retrograde intramedullary cannulated screws with good functional results. Material and methods: We report our short term experience treating nine fifth metacarpal neck fractures, one fourth metacarpal neck fracture and a transverse fifth metacarpal shaft fracture that did not fulfill criteria for conservative treatment. We treated them with minimally invasive osteosynthesis using retrograde intramedullary headless cannulated screws. Results: All patients showed radiographic healing and had full range of motion of the metacarpophalangeal joint at one month follow up except for one patient who suffered a dorsal mutilating hand injury along with a fifth metacarpal neck fracture. One patient had osteoporotic bone and we could not control height loss with screws, so we had to use k-wires. Conclusion: Minimally invasive osteosynthesis with cannulated headless retrograde screws is a good option to treat neck and transverse diaphyseal fractures of the metacarpals. It confers a stable construct that allows early range of motion and return to activities.

Epidemiology and patterns of the hand and distal forearm fractures at King Abdul-Aziz Medical City, Riyadh, KSA

Objectives: The hand is the most commonly fractured site in the body, as it represents 17-25% of all body fractures. The metacarpal bone of the small finger is the most commonly fractured hand bone. This study aimed to determine the epidemiology and frequency of various fractures of the hand and the distal forearm in adults with a view to identifying patients who required surgical treatment

Methods: This retrospective review examined the medical records of all hand and distal forearm X-rays performed on adult patients who presented to the emergency room of King Abdul-Aziz Medical City from January 2010 to December 2011

Results: In this study, we reviewed 2993 X-rays of the hand and the distal forearm. One-third of these X-rays confirmed fractures [n = 948], and more than two-thirds of these fractures were recorded in male patients [n = 702]. There was no major difference in the distribution of fractures between the left and right hand. Half of these fractures [n = 472] were found in the young age group [18-30 years]. The study showed that the phalanges had the highest proportion of fractures [n = 362, 40%]. Distal forearm fractures represented one-third of all registered fractures [n = 287]. Almost half of the metacarpal fractures were found in the 5th metacarpal [n = 104], confirming that the 5th metacarpal bone is the most commonly fractured bone in the hand. One-fifth of all fractures were surgically managed [n = 190, 20%]

Conclusion: One-third of the reviewed X-rays identified hand and distal forearm fractures. Both hands were affected equally. Patients in the young age group are more prone to have fractures, and phalanges had the highest proportion of fractures followed by the distal forearm

Tratamiento de fracturas de metacarpianos con método de banda de tensión / Treatment of metacarpal fractures with tension band method

En estudio clínico prospectivo donde se evaluaron 48 pacientes que acudieron al Servicio de Traumatología y Ortopedía del Hospital General del Oeste "Dr. José Gregorio Hernández", Caracas, Venezuela con 54 fracturas transversas u oblicuas cortas de metacarpianos, entre junio de 1998 hasta septiembre de 2001, tratados con alambre de cerclaje usando el método de banda de tensión. El promedio de edad fue de 28,9 años, siendo las peleas el motivo más común con 79,17 por ciento. El metacarpiano mas afectado fue el 5to metacarpiano para un 72,22 por ciento y el 42,31 por ciento representó el cuello del mismo. La amplitud de movimiento articular fue excelente en 95,83 por ciento y buenos en 4,17 por ciento.

Comminuted Rolando's fractures: treatment with modified wrist external fixator and transmetacarpal pinning.

BACKGROUND: For comminuted Rolando's fracture, external fixation with early mobilization is the treatment of choice however, there is controversy in this treatment. Low-profile or mini external fixator can be used, but expense and availability of this kind of implant in Thailand has resulted in using various techniques of surgery. The purpose of this retrospective study was to present the authors' alternative technique with modified implants and the outcome in the management of comminuted Rolando's fracture. MATERIAL AND METHOD: The patients with comminuted Rolando's fracture were treated by using external fixation across the wrist (mostly by locally-made implants) between the radius and the first metacarpal and transmetacarpal K-wire fixation from the first to the second metacarpal. RESULTS: Between 1999 and 2005, six patients with a mean age of 25 years (range, 19-33 years) were studied The average follow-up period was four months. Satisfactory reductions were achieved in all fractures. The average operation time was 27.5 minutes. All closed fractures united within six weeks and had satisfactory results, which was normal range of motion of thumbs and wrists and with no complications. Only one opened fracture caused by a gun shot injury was healed in eight weeks and had a mild degree of reflex sympathetic dystrophy. CONCLUSION: Closed reduction and external fixation with modified wrist external fixator and transmetacarpal pinning is simple, safe, fast, and effective for the treatment of comminuted Rolando's fractures.

Músculo accesorio del abductor largo del pulgar o tercer abductor / Accessory long abductor muscle of the thumb or third abductor

En el estudio de los tendones del músculo accesorio del abductor largo del pulgar, basados en la disección anatómica de 250 cadáveres adultos de raza mestiza del altiplano y valle, registramos que las variaciones anatómicas son muy frecuentes. La presencia de tendones accesorios ocurrió en todas las piezas disecadas. Este músculo constante, en nuestro medio se origina en el tercio inferior de la cara dorsal del radio, ulna y de la membrana interósea; diferenciandose del abductor largo del pulgar y del extensor corto del pulgar. Se dirige hacia abajo al nivel de la muñeca, pasa por debajo del retináculo extensor en la primera corredera osteofibrosa de la epífisis distal del radio junto con el abductor largo y extensor corto del dedo pulgar. Su inserción distal se realiza en primer metacarpiano.

In the study of the tendons of the accessory muscle of the long abductor of the thumb, based on the anatomical dissection of 250 mature cadavers of mestizo race of the highland and valley, we register that the anatomical variations are very frequent. The presence of accessory tendons happened in all the dissected pieces.This constant muscle, in our means, originates in the inferior third of the dorsal face of the radius, ulna and of the membrane interosseous; differing of the long abductor of the thumb and of the extending one short of the thumb. He she goes down, at the doll's level, it passes below the extending retináculo in the first sliding osteofibrosa of the lower extremity of the radius together with the short long and extending abductor of the thumb. Their insert distal is carried out in first metacarpal.

Kirschner wire pin tract infection rates between percutaneous and buried wires in treating metacarpal and phalangeal fractures

To compare pin tract infection rate between percutaneous and buried placement of Kirschner [K-] wiring for hand fractures. Quasi ' experimental study. Place and Duration: Plastic, Reconstructive, Hand and Burn Surgery Unit, Liaquat National Hospital, Karachi, from September 2005 ' February 2006. Patients and Patients with fractures of metacarpals and phalanges of hand were selected by non-probability purposive method. Assessment of pin tract infection by clinical examination and pin tract scoring was done by modification of Oppenheim classification. Statistical analysis was done using Chi-square test. Ten out of 55 percutaneous and 2 out of 45 buried wires were infected. The difference in infection rates of two groups was statistically significant at p < 0.05. Three percutaneous, but not buried Kirschner wires, had to be removed before 4 weeks because of failure to respond to local wound care and oral antibiotics. Percutaneous K- wires had significantly greater infection rate than wires which were buried deep to the skin

Reconstrucción de metacarpiano en heridas por armas de fuego / Reconstruction of metacarpal wounds by firearms

Estudio prospectivo tipo serie de casos que describe la experiencia del Hospital Militar Central entre Diciembre de 1995 y Diciembre del 2002, en 35 pacientes, con fracturas de metacarpianos ocasionados por armas de fuego de alta velocidad, con defectos segmentarios tratados con injerto óseo tricortical y osteosíntesis estable. 100 % sexo masculino y promedio de seguimiento de 17 meses (9 - 24). Como consideraciones para este tratamiento se tiene la viabilidad funcional del dedo, presencia de infección, compromiso de tejidos blandos y condiciones generales del paciente. Manejo inicial fijación transitoria con clavos, lavados quirúrgicos y férula de protección. Los resultados mostraron integración ósea en 12.5 semanas (8 a 32), pérdida función MF del 20 % y baja tasa de complicaciones. Se recomienda este tipo de procedimiento como una buena alternativa de tratamiento en este tipo de lesiones.