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

Fracturas de falanges tratadas con placas de osteosintesis: Resultados a corto plazo / Phalangeal fractures treated with osteosynthesis plates. Short-term results

Introducción: Se realizo un estudio de cohorte prospectivo para evaluar los resultados funcionales de pacientes laborales con fracturas de falange tratadas mediante placas y establecer factores de mal pronostico. Materiales y Métodos: Desde mayo de 2012 hasta mayo de 2014, 55 pacientes laborales con fracturas de falange fueron operados consecutivamente, mediante reduccion y osteosintesis con placa y tornillos. Cuarenta y dos (39 hombres, edad promedio 30.76 anos) fueron evaluados, con 68 falanges operadas (primera falange 15, segunda falange 53). El 28% de las fracturas fueron expuestas; el 38,24%, conminutas y el 11,76% tenia compromiso articular. El seguimiento promedio fue de 3.38 meses. Resultados: Se logro la consolidacion osea de todas las fracturas a los 1.8 meses. La movilidad para el pulgar (Gingrass) fue buena en dos casos y regular en uno. En los restantes dedos (Belsky), fue excelente (35%), buena (55%) y mala (9%). El puntaje DASH promedio fue de 18,53. Se observaron peores resultados en las fracturas de la primera falange respecto de la segunda falange y en pacientes con mas edad que en los mas jovenes, ambos con significancia estadistica. No hubo relacion entre el resultado y las demas variables estudiadas. Cuatro pacientes tuvieron complicaciones (9,5%). Conclusiones: Al comparar nuestra serie con otras publicadas, hubo menos complicaciones y los resultados fueron similares, pero a diferencia de otros autores, no acostumbramos a retirar el material ni a realizar tenolisis ni artrolisis. Se logro la consolidacion osea en todos los casos y los resultados fueron satisfactorios en el 90% de los pacientes. Nivel de Evidencia: IV

Introduction: A prospective cohort study was carried out to evaluate functional results in workers with phalangeal fractures treated with plates and to establish poor prognostic factors. Methods: From May 2012 to May 2014, 55 workers with phalangeal fractures were operated on consecutively by reduction and fixation with plate and screws. Forty-two patients (39 men; average age 30.76 years) were evaluated, with 68 operated phalanges (first phalanx 15, second phalanx 53). Twenty-eight percent of fractures were open, 38.24% comminuted and 11.76% had joint involvement. Average follow-up: 3.38 months. Results: Bone union was achieved in all fractures in 1.8 months. Gingrass score for the thumb was good in two cases and regular in one. In the remaining fingers, Belsky score was excellent (35%), good (55%), and poor (9%). Average DASH score was 18.53. Worse results were observed in the first phalanx fractures with respect to the second and in older patients than in the younger, both with statistical significance. No relationship was observed among the outcome and other variables studied. Four patients had complications (9.5%). Conclusions: When comparing our findings with other studies, the rate of complications was small, and similar results were obtained, but unlike other authors, we are not used to removing hardware with tenolysis or arthrolysis. Bone union was achieved in all cases and results were satisfactory in 90% of patients. Level of Evidence: IV

Luxación de tendones extensores de la mano a nivel metacarpofalángico (zona V de Verdan) / Dislocation of the extensor tendons of the hand at the metacarpo-phalangeal level (zone V of Verdan)

Resumen: La luxación de los tendones extensores a nivel metacarpofalángico (MCF) de los dedos es una alteración mecánica poco frecuente que se caracteriza por incompetencia o ruptura de la banda sagital (BS), estructura que estabiliza dichos tendones. Se manifiesta por desplazamiento cubital del tendón extensor (en raras ocasiones, la luxación es radial o divergente), que limita su función y puede causar dolor o chasquido. El diagnóstico se hace al observar el tendón extensor del lado cubital de la articulación MCF en flexión del dedo. El tratamiento debe ser conservador cuando el diagnóstico se efectúa en las primeras tres semanas. Se recomienda tratamiento quirúrgico cuando el diagnóstico es tardío. Existen varias técnicas de reparación quirúrgica. Material y métodos: Se revisaron bases de datos electrónicas (Ovid y Medline) en busca de artículos relacionados con esta patología. Se examinaron los casos de luxación de tendones extensores en zona V en nuestros pacientes. Resultados: Se encontraron 10 artículos y cuatro libros relacionados con esta patología. Analizamos 18 individuos con 21 lesiones de Abril de 1978 a Agosto de 2011; de ellos, 10 fueron hombres y ocho mujeres, con edad de 21 a 73 años (promedio, 47 años). El dedo más afectado fue el medio (con 13 casos), seguido del índice (con cinco casos), el meñique (con dos casos) y el anular (con un caso). Trece sujetos fueron tratados quirúrgicamente y ocho de forma conservadora. Las técnicas quirúrgicas utilizadas fueron: de Wheeldon en siete personas, combinación de reparación primaria con técnica de Wheeldon en cuatro casos, reparación primaria de la BS y técnica de Carroll en un paciente cada una. El seguimiento mínimo fue de un año y el más largo de 34 años (promedio, 17.5 años). Discusión: Las lesiones de tendones extensores en zona V son poco frecuentes. Cuando el diagnóstico es tardío, requieren tratamiento quirúrgico.

Abstract: Traumatic dislocation of the extensor tendon over the metacarpophalangeal (MCP) joint is a rare lesion that is caused by the dysfunction or rupture of the sagittal band, which is an important stabilizing structure of the extensor tendon. This mechanical alteration presents itself as instability that affects function and may cause pain or snapping during finger motion. The diagnosis is made when ulnar dislocation of the extensor tendon is observed over the MCP joint. Nonsurgical treatment is successful and should be attempted when injuries are diagnosed within the first three weeks. Several surgical repairs have been described. Material and methods: We searched medical databases (Ovid, Medline) for papers on extensor tendon dislocation. We also revised our own cases of this injury. Results: Our search resulted in 10 articles and four books. We found 18 patients with 21 injuries, 10 men and eight women. The most frequently affected finger was the middle one (in thirteen cases), followed by the index (in five cases), the fourth finger (in two cases) and the third one (in one case). Eight of our patients were treated conservatively and thirteen required surgical treatment. The surgical procedures performed were Wheeldon's in seven cases; primary repair of the sagittal band and Wheeldon in four cases; primary repair alone in one case; and Carroll's in one case. The follow-up was between one and 34 years (average: 17.5 years). Discussion: Extensor tendon dislocation in zone V is rare. When the diagnosis is made after three weeks of the lesion, the surgical treatment is recommended.

Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw / Tratamento cirúrgico minimamente invasivo das fraturas instáveis da falange proximal: parafuso intramedular

To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r)). METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r)). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r)) is effective and safe, and it presents satisfactory clinical-functional results.

Analisar os parâmetros clínico-funcionais e a qualidade de vida de pacientes submetidos ao tratamento cirúrgico minimamente invasivo das fraturas extra-articulares da falange proximal com uso do parafuso intramedular (Acutrak(r)). MÉTODOS: Um estudo prospectivo foi feito de janeiro de 2011 a setembro de 2014 e incluiu 41 pacientes e 48 dedos acometidos com fratura da falange proximal extra- articular e instável submetidos ao tratamento cirúrgico minimamente invasivo com parafuso intramedular (Acutrak(r)). Esses pacientes foram avaliados 12 meses após a cirurgia por meio do questionário DASH de qualidade de vida, escala de dor VAS, arco de movimento (adm em graus) e avaliação radiográfica. RESULTADOS: Todos os pacientes obtiveram redução adequada e consolidação das fraturas. Houve melhoria estatisticamente significativa da qualidade de vida (DASH), escala de dor (VAS) e arco de movimento. CONCLUSÃO: A técnica minimamente invasiva no tratamento das fraturas instáveis e extra-articulares da falange proximal com o parafuso intramedular Acutrak(r) é eficaz e segura e apresenta resultados clínico-funcionais satisfatórios.

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

Management of Proximal Phalangeal Fractures of the Hand Using Finger Nail Traction and a Digital Splint: A Prospective Study of 43 Cases

BACKGROUND: Proximal phalangeal fractures are common fractures of the hand. The fractures are difficult to treat because of vicinity of two important joints and crossing long tendons. The purpose of this study was to evaluate the efficacy of nail traction technique in the management of proximal phalangeal fractures of the hand. METHODS: Patients (n=43) with proximal phalangeal fractures were treated by nail traction and evaluated prospectively. We assessed all the patients at the time of presentation and then followed a standard protocol for recruiting patients. After application of nail traction, the patients were initially assessed at 12th day. The outcome measures included post reduction radiographic evaluation and total active motion (TAM) in finger at the final follow-up appointment. All the patients were followed for one year. RESULTS: The post-reduction X-ray evaluation showed good reduction in 33 cases, fair reduction in 8 and poor reduction in 2 cases. At final assessment, 35 patients had good TAM score, six had fair and two had poor TAM score. Complications were noted in two patients and these included pressure necrosis in palm and stiffness in proximal interphalangeal joint. CONCLUSIONS: The results of this prospective study show that with careful selection of patients, nail traction seems to be simple, safe and effective technique for managing proximal phalangeal fractures.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

Anatomic Reduction of Mallet Fractures Using Extension Block and Additional Intrafocal Pinning Techniques

BACKGROUND: The purpose of this article is to report the efficacy of the extension block pinning and additional intrafocal pinning technique applied to cases whose mallet fractures were not reduced with extension block pinning alone. METHODS: We retrospectively reviewed 14 digits with 14 patients who were treated with the extension block pinning and additional intrafocal pinning technique. There were eight men and six women with an average age of 34 years. The average articular surface involvement was 52%. The average follow-up was 16 months and the mean time from injury to operation was 23 days. RESULTS: All the cases achieved anatomic reduction of fractures. By Crawford's classification, 9 were excellent and 5 were good. The average active flexion of the distal interphalangeal joint was 78 degrees and the average extension loss was 1.8 degrees. Bone union was observed in all cases after a postoperative mean of 38.4 days. Complications such as skin necrosis, fracture of bony fragments, and nail-plate deformity were not found. CONCLUSIONS: Additional intrafocal pinning technique is considered a simple and useful method to obtain anatomic reduction of mallet fractures in cases where extension block pinning alone is insufficient to restore the anatomic configuration of the articular surface.

[Treatment od dorsal fracture dislocation of the proximal interphalangeal joint with arthrodesis technic: about 19 cases]

Trojan fracture is an unstable lesion which associate an anterior marginal fracture of the second phalanx base and a dorsal dislocation of the first interphalangeal joint under the influence of the extensor traction. The instability of this lesion is more important when the anterior marginal fragment is big. Various techniques were described, we report our experience using the arthrorise's technique to treat this lesion. The procedure associate a reduction of the fracture and the dislocation using a dorsal pinning. This procedure is simple and allows an early physiotherapy, important for this joint. We used this procedure in 19 Trojan fractures between 1995 and 2002 awl at 3 years follow-up our results based on functional, clinical and radiological criteria were satisfactory

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

Shock eléctrico asociado a fractura de falange media del dedo medio de mano izquierda / Electric Shock associated to fracture of half phalange of the half finger of hand left

Lesiones por shock eléctrico son descritas en la literatura determinando lesiones locales y sistémicas. Lesiones esqueléticas como luxaciones y fracturas son infrecuentes en nuestras emergencias; aparentemente asociadas a contracciones tetánicas de la musculatura circundante. Describimos un paciente femenino, 43 años, ingresado a la emergencia posterior a sufrir choque eléctrico con electrodoméstico (nevera), refiere sitio de entrada en cara volar de los últimos cuatro dedos de mano izquierda, con exposición aproximada de 30 segundos, se interrumpe desconectando electrodoméstico, niega perdida de conciencia y traumatismo directo e indirecto en miembros. Niega antecedentes importantes. Signos vitales normales, sin signos de traumatismo corporal, posterior al ingreso refiere molestia para la flexo-extensión de mano izquierda, presentando dolor a la palpación profunda sobre la Falange Media del dedo medio. La Radiografía Postero-Anterior evidencia fractura espiroidea no desplazado desde apífisis distal hasta diáfisis de Falange medial del dedo medio de la mano izquierda. Es inmovilizada con férula digital, observada durante 24 horas y egresada previo descarte de lesiones sistémicas importantes. Estas fracturas son de fácil diagnóstico cuando comprometen articulaciones y huesos grandes pero nunca olvidar las fracturas de huesos y articulaciones pequeñas ante una clínica leve.

Mini-screw fixation for certain fractures of the phalanges and the metacarpals

68 patients with phalangeal or metacarpal fractures were treated in the emergency department at Bab-Elshareia university hospital and health insurance hospital by open reduction and internal fixation using inter-fragmentary lag screw stabilization technique. Operative stabilization was considered because we failed to restore fracture alignment at closed attempts, or fractures failed to maintain closed reduction in plaster immobilization after conservative trials, Phalangeal fractures were accounted for 45 [66.2%] of the total, the remaining 23[33.8%] were metacarpals. There were 59 [86.8%] males and 9[13.2%] females. The youngest patient was 18 years old and the oldest was 55; the mean age was 27 years. All fractures were unstable. The fracture pattern was displaced spiral in 49 [72.1%] cases and displaced oblique in the remaining 19[27.9%]. There were 39[57.4%] injuries to the left hand, 29[42.6%] to the right, and in no instance was there an injury to both hands. Considering all 68 fractures, direct blow was accounted for 80.9% of the total, whereas indirect forces was instrumental in only 19.1% of the fractures. Most of the injuries 39[57.4%] had occurred in young labor men. Athletic injuries, 20[29.4%] fractures had occurred in young adult students. Indoor injuries, 9 [13.2%] fractures had occurred only in females, most of them were in the 5th decade of life. All injuries were closed single-bone fracture. None of the fractures was pathological none was intra-articular and none of the patients had other additional injuries elsewhere, but one, suffered in addition, ipsilateral fracture distal radius. The overall results at final follow-up were excellent in 61[89.7%] patients, and good in 7[10.3%]

Pseudotumor en hemofílicos: localizado en la falange de la mano con tratamiento percutáneo: reporte de un caso / Pseudotumor in hemophiliacs: located in the phalanx of the hand with percutaneous treatment: a case report

Es importante dar a conocer esta nosológica, la pueden confundir con tumores malignos. La hemorragia en hueso adyacente origina áreas de rarefacción localizada y que conducen a un pseudotumor hemofílico quítico, la etiopatogenia es poco conocida, cuando ocurren en manos y pies son de crecimiento rápido y florido en pacientes jóvenes con epífisis de crecimiento fértiles. El adecuado tratamiento precoz del pseudotumor permite cirugías más sencillas con recuperación más rápida e incorporación a su entorno social y familiar. El tratamiento inicialmente conservador con la administración de Factor VIII, en aquellos tumores cuyo crecimiento es incontrolable exige tratamiento quirúrgico. Se evaluará el pseudotumor, la exige tratamiento quirúrgico. Se evaluará el pseudotumor, la existencia de una o múltiples cavidades, si amerita el aspirado de la sangre o una incisión pequeña para la evacuación de los coágulos, curetaje de las cavidades, llenado de la cavidad con cola de fibrina, la cual se elabora en el Centro Nacional de Hemofilia con sede en el Banco Municipal de Sangre del Distrito Federal por no contar con los recursos para su importación. El tratamiento percutáneo es un método no agresivo indicado cuando las lesiones aumentan continuamente de tamaño a pesar del tratamiento preventivo el manejo de estos pacientes debe ser realizado por un grupo multidisciplinario que incluye: hemotólogos, cirujano ortopedista, fisiatra y trabajadora social para la adecuada evaluación que evitaría el desarrollo de complicaciones.