Management of Complex Hand Injuries with Suspension Interposition Arthroplasty and Carpometacarpal Joint Buttress Plating Based on Intra-operative Creativity and Flexibility: A Case Report

@#A young patient presented to our centre with swollen right hand following a motor vehicle accident. He was diagnosed with closed fractures of trapezoid, ulnar three metacarpal bones, radial styloid and ulnar styloid. The hand injuries were complicated with compartment syndrome. Emergent fasciotomy and application of external fixator of the hand were performed. Definitive fixation of the fractures was delayed due to the wound care post fasciotomy. During the definitive fixation of the hand, the trapezoid was found to be comminuted and completely extruded. Abundant callus was found at the fracture sites of the metacarpal bones. Anatomic fixation was not feasible. Principle-based intra-operative creativity and flexibility were of great significance in the unconventional fixation of the complex hand injuries described in this case report.

A Comparative Study of Operative Management of Intraarticular Fracture Distal end of Radius (External Fixator Versus ORIF with Buttress Plating)

Background: Intraarticular fracture distal end of the radius isone of the most common fracture of upper extremities. Here israndomised comparative study of the most effective treatmentmodality to deal with such fracture by external fixator vsbuttress plating.Method: Patients were randomly allocated into two groups of30 each (group A and group B). Patients treated with externalfixator was put in group A while those treated with buttressplating was kept in group B. At the end of 8 months of follow-upfinal assessment was done for fracture union and patients wereassessed for pain, wrist range of motion (ROM), grip strengthand activity and scored according to the Modified Green OBrien Scoring System. The mean duration of treatment and theoutcome were comparable.Results: In group A (external fixator) only 7 patients hadexcellent and 18 had good results while patient in group B(ORIF with plating) 14 patients had excellent and 11 had goodresult.Conclusion: We found that plating predominantly providesmore excellent results as long as the radiological parametersare met and fixation achieved as early as possible along withvigorous physiotherapy.Level of Evidence: Level II randomised comparative series.