Association of Apolipoprotein E Polymorphisms with White Matter Lesions and Brain Atrophy

Objective@#Apolipoprotein E (ApoE) is mainly synthesized in the liver. So far, it is unknown the relationship among APOE gene polymorphisms and WML, brain atrophy. Therefore, the aim of the study was to assess the associations of APOE gene polymorphisms in patients with WML and brain atrophy. @*Methods@#A total of 58 patients with WML, 128 patients with brain atrophy, 112 patients with co-occurrence of WML and brain atrophy and 95 healthy elderly volunteers were recruited from Renmin Hospital of WuHan University. @*Results@#Allele E3 was the most common allele. The alleles E2 had significantly higher levels of ApoB and lower age in WML group. The alleles E2 was associated with the lower level of ApoB, LDL-Ch, TCh, and sdLDL in co-occurrence group. The E3/E3 genotype has higher level of sdLDL, but lower age and female frequency in WML. The E3/E4 genotype had higher level of TG, but lower age in WML. Gender, Age, E2, Hyperhomocysteinemia and UA were also significantly associated with disease progression. @*Conclusion@#This study found that clinical data, lipids and metabolic complications were closely related to ApoE genotypes and alleles, and also disease progression and type.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture / 中华医学杂志(英文版)

Background@#The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures.@*Methods@#Six normal cadaveric hamates were investigated with red lead (Pb3O4) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied.@*Results@#A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook.@*Conclusions@#This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture / 中华医学杂志(英文版)

BACKGROUND@#The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures.@*METHODS@#Six normal cadaveric hamates were investigated with red lead (Pb3O4) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied.@*RESULTS@#A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook.@*CONCLUSIONS@#This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.

Three-dimensional Intralunate Arteries Visualization with Red Lead (PbO) Angiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The etiology of Kienböck's disease is controversial, and the blood supply is a possible pathogenic factor. The red lead (Pb3O4) angiography with micro-computed tomography (micro-CT) of lunate to investigate intralunate arteries has rarely been reported. This study aimed to investigate a new, reasonable, and simplified technique to study the intraosseous arterial pattern of normal lunates.</p><p><b>METHODS</b>This study investigated the intraosseous arterial pattern of six normal cadaveric lunates through Pb3O4injection and three-dimensional reconstruction with micro-CT. The intraosseous arteries of all specimens were clearly enhanced. The data of enhanced arteries and nutrient foramina were shown as median (Q1, Q3) and analyzed with Wilcoxon signed-rank test.</p><p><b>RESULTS</b>The mean number of total nutrient foramina was 2.00 (1.75, 2.00) on the palmar side and 3.50 (2.50, 4.25) on the dorsal side. The number with enhanced arteries on the palmar side was 1.00 (0.75, 2.00) and on the dorsal side was 3.50 (1.75, 4.00). There were no significant differences between the number of nutrient foramina on the palmar and dorsal sides of the lunates, no matter the total number or enhanced arteries. The intraosseous arterial pattern in normal lunates can be classified into three types: the dominate stems from the palmar side, from the dorsal side, and from both sides with anastomosis.</p><p><b>CONCLUSIONS</b>The Pb3O4angiography with micro-CT is a simplified, quicker, and reliable method to study intraosseous arteries.</p>

Development of a New TaqMan-MGB Probe-Based Real-Time qPCR Method for the Detection of HCV-RNA / 现代检验医学杂志

Objective Developing a rapid and accurate real-time qPCR method for the detection of HCV-RNA.Methods HCV nucleotide sequence was analysed in Clustal software and primers and probe were designed in the conserved region of 5'UTR.The reaction system optimization of real-time qPCR method was used chessboard titration,pseudoviral particles were used as quantitative standard to assess the performance.New methods was compared with clinical commonly used kit of HCV-RNA and discuss the application value.Results The sensitivity of new real-time qPCR method was 50 IU/ml,coefficient variation was less than 5％.The quantitative results of this method could be traceable to national standards of GBW09151a.40 samples were determined by new methods and clinical commonly used kit of HCV-RNA,the positive concordance rate was 100 ％,the negative concordance rate was 56 ％.14 samples were positive by new method,but negative by Qiagen kit,illustrating that the sensitivity of new method was superior to Qiagen kit.Conclusion New TaqMan-MGB probe-based real-time qPCR method is a specific,sensitive,simple,rapid and exactly used to detection of HCV-RNA.

Construction of a finite element model based on lunate sagittal Micro-CT images and its stress analysis / 中国组织工程研究

BACKGROUND: Biomechanical mechanisms are complex, and previous studiers focus on the stress conduction in the carpus. However, the stress distribution and characteristics of trabecula in the carpus are rarely reported.OBJECTIVE: To investigate the stress distribution and deformation characteristics of the normal lunate through a two-dimensional sagittal finite element model.METHODS: A normal cadaveric lunate sample was scanned with Micro-CT and the central sagittal image was chosen for further finite element analysis (FEA). The chosen image was processed and imported into the finite element analysis software (Ansys 14.0). A two-dimensional sagittal finite element model of the lunate bone was established. Axial pressure was applied to the model with the wrist held in different positions, and nine regions of interests (ROIs) were identified, for which stress and displacement nephograms were created. These included the first principal stress (S1, the maximum stress in a principal plane), the third principal stress (S3, the minimal stress in a principal plane), shear stress (SXY, the component of stress coplanar with a material cross section), von Mises stress (SEQV, yielding begins when the elastic energy of distortion reaches a critical value)and displacement of each ROI (UY, displacement on the vertical plane of the lunate) which were calculated and compared.RESULTS AND CONCLUSION: (1) The stresses on ROIs located in the proximal and volar cortices of the lunate bone were much higher than those in the distal and dorsal cortices. At the proximal lunate, S1 was less than S3; however at the distal lunate, S1 was greater than S3. The ROIs of the distal and proximal ends of the lunate bone received much higher stress than the ROIs of the middle part. As for axial trabecular displacement,both distal and proximal ROIs were compressed by axial pressure. However, the dorsal and the volar parts of the proximal lunate moved in different directions at different wrist postures. Besides, the stress values and magnitudes of displacement were elevated in wrist flexion and extension compared to neutral position.Furthermore, the stress concentration zones (the proximal volar ROI, the proximal dorsal ROI, the distal volar ROI, and the distal dorsal ROI) had different directions of shear stress and displacement in different wrist postures. (2) These results suggest that when stress is loaded on a normal lunate model, four stress concentration zones, the proximal volar ROI, the proximal dorsal ROI, the distal volar ROI, and the distal dorsal ROI are found. The wrist postures can significantly affect the value and distribution of axial stress on the sagittal lunate.

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures.</p><p><b>METHODS</b>Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively.</p><p><b>RESULTS</b>At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion (ROM) of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. Compared with the contralateral hand, the grip strength of the injured hand was 94.0 ± 9.6%. X-rays showed that the arch of the second to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings.</p><p><b>CONCLUSION</b>The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and fifth metacarpal fractures with good early clinical outcomes and no significant complications.</p>

Analysis on Gene Polymorphism of UGT1A1 Gene Promoter in Patients with Malignant Tumour / 现代检验医学杂志

Objective To detect UGT1A1 gene promoter polymorphism with gene sequence method and analyze the distribu-tion of UGT1A1*28 and UGT1A1*6 gene polymorphism in Wuhan.Methods A total of 230 samples were collected from tumor patient in Medical Oncology Department of Renmin Hospital of Wuhan University from January 2013 to December 2014,then gene sequence of the target fragments were detected by Sanger sequencing method and analyzed patient UGT1A1 gene promoter polymorphism TA box.Results In this research examination 230 example tumor patient,198 patients (86.1%)were identified with TA6/TA6 genotype,29 patients (12.6%)were identified with TA6/TA7 genotype,3 pa-tients (1.3%)TA7/TA7 variant.Conclusion TA6/TA6 wild-typewas higher frequence in patients with malignant tumour in Wuhan.

Clinical typing of lumbosacral plexus nerve root injury caused by trauma / 中华骨科杂志

ObjectiveTo classify the type of lumbosacral plexus nerve root injury.MethodsFrom November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.ResultsLumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.ConclusionThis clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.

Histological changes of wrist interosseous ligaments after radiofrequency electrothermal shrinkage / 中华创伤杂志

Objective To explore the histological changes of the wrist interosseous ligaments after radiofrequency electrothermal shrinkage. Methods Six frozen fresh male adult cadaver wrist ligaments were exploited for the research. The ligaments of the right wrists were treated with radiofrequency electrothermal shrinkage with Arthrocare system, while the ligaments of the left wrists were kept as the normal control. The bone-ligament-hone samples of all the scapholunate (SL) and lunotriquetral (LT) ligaments were prepared, sectioned and then stained with the regular HE staining, toluidine blue staining, Sirius-red staining and immunohistochemistry staining of collagen Ⅲ. The image analysis software was used to compare the staining results. Results The histological structures of SL dorsal ligaments (SL-d) and LT volar ligaments (LT-v) were very similar, and the structures of SL volar ligaments (SL-v) and LT dorsal ligaments (LT-d) were also very similar. The membrane parts of both SL and LT ligaments showed the fibrous cartilage structure. The histological structures of SL-d and LT-v were much less destroyed by the radiofrequency than those of SL-v and LT-d. After radiofrequency electrothermal shrinkage, only the distribution areas of collagen Ⅰ and collagen Ⅲ were significantly changed in the membrane parts of SL and LT ligaments. Conclusion Radiofrequency electrothermal shrinkage treatment can cause minor structural damage to the collagen-dominant ligaments such as SL-d and LT-v, while it can lead to quite severe structural damage to the ligaments containing collagen and lots of loose connective tissue, such as SL-v and LT-d.

Clinical classification and treatment strategy of hamate hook fracture / 华中科技大学学报（医学）（英德文版）

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Clinical classification and treatment strategy of hamate hook fracture / 华中科技大学学报（医学）（英德文版）

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Remolding of the reconstructed finger by toe to hand transfer / 中华显微外科杂志

Objective To design technique of local flap transposition to refine the aesthetic appearance of reconstructed fingers by toes transfer.Methods Nine cases with 21 reconstructed finger were included,which involved 6 males and 3 females with an average age of 21.8 years(range,18-34years).A lingual contour flap with a lateral pedicle Was shifted from the inflated distal pulp to the narrow middle part of the"finger"to refine the aesthetic appearance.Overall results were evaluated in terms of the survival of the flap,the appearance improvement and the functional influence of the reconstructed finger.Results All of the flaps survived and healed perfectly.After a mean follow-up of 9.3 months(range,6-12months),the appearance of the reconstructed fingers were impmved apparently.There was little influence on the function of the finger.The results showed that all the patients gained more acceptable fingers.Conclusion From our experience,local flap transposition is a useful method for remolding of reconstructed fingers by toes transfer.

Parkinsonism with long term use of lamivudine

This is a report of 3 cases of parkinsonism with long term administration of lamivudine. The clinic features were mask like faces, shuffling gait, lethargy and reduced automatic movement. After stopping use of lamivudine and treatment of anticholingeric drugs, the symptoms and signs of all cases were ameliorated. The possibilities of Wilson’s disease and other secondary parkinsonisms were excluded. The parkinsonism was attributed to complications from lamivudine. Lamivudine associated parkinsonism has not been reported previously in the medical literature.

Preliminary linkage analysis of a Chinese family with benign familial infantile convulsion / 中华儿科杂志

<p><b>OBJECTIVE</b>Benign familial infantile convulsions (BFIC) is a recently recognized autosomal dominant inherited disorder. This epileptic syndrome typically begins between 3 and 12 months of age with clusters of partial seizures in most cases and carries a good prognosis. So far, three loci have been linked to chromosome 19q12.1-13.1, chromosome 2q24 and chromosome 16p12-q12. The authors performed linkage analysis on this pedigree.</p><p><b>METHODS</b>A four-generation Chinese family was investigated. The total number of members was 32 in this family and two neurologists in Xiangya Hospital gave systemic physical examinations and interictal neurological examinations to nineteen members of this family. Venous blood samples were taken for genetic analysis. DNA was extracted from peripheral blood leukocytes using phenol-chloroform method. Seventeen microsatellite markers spanning the critical regions on chromosomes 19q12-13.1, 2q24, and 16p12-q12 were genotyped. These markers included D19S49, D19S250, D19S414, D19S416 and D19S245 for the 19q region, D2S2380, D2S399, D2S111, D2S2195, D2S2330 and D2S2345 for the 2q region, D16S401, D16S3131, D16S3093, D16S517, D16S3120 and D16S415 for the 16p-q region. The DNA from each sample was amplified for the 17 markers. After polymerase chain reactions (PCR), PCR products of chromosome 19 with markers D19S49, D19S250, D19S414, D19S416 and D19S245 were subjected to electrophoresis on 8% denatured polyacrylamide gel for at least 2 hours and 20 minutes. Then the length of the PCR products was judged in the Strategene Eagle Eye II automated gel image analyzer. For the markers from chromosome 2 and 16, PCR products were scanned at ABI 377 autosequencer. The data of PCR products were analyzed using the software Genescan v3.1, Genetyper v2.1 (Applied Biosystem, CA. USA) and GenoDB v1.0. After Mendelian checking, the eligible genotyping data were used for linkage analysis. LOD scores were calculated by using MLINK program of LINKAGE v5.1, under an assumption of autosomal dominant inheritance and the estimated penetrance was 0.9. The allele frequencies of each marker were assumed to be equal and the disease-allele frequencies were designated to be 1/10,000. The LOD scores were calculated at combination rate (theta) 0.0, 0.1, 0.2, 0.3, and 0.4.</p><p><b>RESULTS</b>Among the 17 selected microsatellite markers, which cover the previously reported regions, seven markers' data (D16S3131, D16S517, D16S3120, D16S3093, D2S2380, D19S250 and D19S414) were omitted due to failed genotyping, low genetic heterogeneity, or failure to pass Mendelian checking. Omission of these markers was to ensure the reliability of our raw data. The two-point LOD scores were below zero for all the markers and the maximum LOD scores at theta = 0.0 were less than -2 for markers D19S49, D19S416, D19S245, D16S401, D16S415, D2S399, D2S111, D2S2195, D2S2330 and D2S2345. Thus, the linkage result showed no evidence that the disease locus is linked to any of these selected markers, which excludes the previously reported candidate regions found in other ethnic families.</p><p><b>CONCLUSION</b>There is no evidence that this Chinese family was linked to one of the following loci: 19q12.1-13.1, 16p12-q12 and 2q24. The results indicated that BFIC showed genetic heterogeneity and the Chinese BFIC families might be mapped on another new locus.</p>

Diagnosis and treatment of baseball elbow / 中华骨科杂志

Objective To evaluate the methods of early diagnosis and the surgical outcomes of se vere baseball elbow.Methods Six surgically treated cases of base ball elbow were included in this stud y.Two patients were treated with arthrosc opy to remove free loose bodies in elb ow joints and synovectomy.Another t wo patients had the big free loose bodie s removed with both arthroscopy and s urgical interventions through small incisions.The remaining 2underwen t d?bridement,cartilage repair and subchondral bone graft.Careful physical examinations as well as X -r ay,CT,3D -CT and MR were performed an d compared before and after operations.Results All the patients suffered from elbow pain and limitations of elbow extension.Limitations of elbow flexion and forearm supination could be seen in some severe cases.MRI was helpful for detecting early lesions.Compared with plain radiograph,it was more sensitive to conduct tomography or roentgenography at 45degrees flexion of elbow.3D -CT coul d illustrate the conditions of cartilage and free loose bodies vividly.T he patients were followed up with an average range of 8.2months postoperatively.The results were evaluated in 4aspects,which included elbow pain,range of motion,joint snap and image features.Three patients had ex-cellent results,two had good and one fair.Five patients got an average in crease of elbow extension for 10degrees.Two of them were competent f or their original job after operatio ns.One patient had gone back to the baseball fields after one-year rehabilitation.Conclusion Careful physical examination and im aging evalu-ations as MRI,tomography or roentge nography at 45degrees flexion of elb ow were essential for early diagnosis.For the patients suffering from base ball elbow,the best results could be obtained with early diagnosis and proper treatments.The surgical out comes tend to be better in the younger patients with the shorter duration o f the disease and less invasive treatm ents.[

Treatment of metacarpophalangeal intra-articular fractures assisted with metacarpophalangeal arthroscopy / 中华骨科杂志

Objective To explore the clinical results of metacarpophalangeal(MP) intra-articular fractures treatment assisted with MP arthroscopy. Methods Five patients suffered from MP joint fractures were treated with closed reduction and K-wire fixation under the MP arthroscopy. The age of the patients was from 17 to 53 years with an average of 23.5 years. There were four males and one female. All the fractures were caused by direct trauma. The head of metacarpal bone was injured in one case while the bases of proximal phalange were involved in four cases. 2 were of simple fractures and 3 of comminuted fractures. No joint surface defects were found preoperatively. The duration from injury to surgery was from 5 days to 3 weeks. The treatment results were evaluated with respect to MP arthroscopical findings, the fracture union and the postoperative function. Results The fracture lines could be seen in 4 cases under arthroscopy except one located at the palmar aspect of metacarpal head, which was then treated with open reduction and internal fixation. During the examination with MP arthroscopy, one case each of volar plate injury and collateral ligament injury was found. The patients were followed up 3-6 months with an average of 4.8 months postoperatively. All the patients obtained fracture union with a smooth joint surface. The motion of involved MP joints achieved nearly to their normal active range in 3 cases. No pain or snapping was found during the movement of MP joints. There was also no lateral instability. Only in one case, because of the massive and comminuted fracture, the involved finger was immobilized with plaster for five weeks, the ROM of MP joint became 90? for flexion and -56? for extension at 5 months postoperatively. Conclusion It is a less invasive procedure with good results to treat MP joint fractures assisted with MP arthroscopy. It is suitable for some acute MP intra-articular fractures.