Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal.

The purpose of this study was to describe the results of extra-articular and intra-articular fractures, at the base of the first metacarpal, treated with closed reduction and percutaneous fixation with intermetacarpal Kirschner wires. Outcome was evaluated by experienced pain, functional outcome and radiographic indications for arthritis. In total, 25 patients with unstable fractures at the base of the first metacarpal underwent closed reduction and percutaneous fixation of the fracture. Prospectively collected data of 25 consecutive patients were evaluated retrospectively, assessing stability of fixation, operation time and the occurrence of fracture dislocation during and after treatment. All patients were assessed at 1, 3, 6 and 24 months. Follow-up included questionnaires: functional tests including grip and pinch measurement and radiographic analysis for post-traumatic arthritis, using the modified Eaton-Littler classification. In total, 15 patients with extra-articular fractures and 10 patients with intra-articular fractures were treated with this technique. In the group of extra-articular fractures of 15 patients, only one patient had loss of grip strength greater than 20% in comparison with the contra-lateral side (corrected for hand dominance). No clinically important difference was found for pinch strength. One patient experienced functional limitations and was unable to return to a previous hobby. In the patients group with intra-articular fractures, seven patients had a Bennett fracture and three a Rolando fracture. One patient with a Bennett fracture had a loss of pinch strength greater than 20% corrected for hand dominance. One of the three patients with a Rolando fracture had grip loss greater than 20%. None of the patients with intra-articular fractures experienced any functional limitations. The described fixation procedure results in a stable fixation of the fracture fragments, and no secondary dislocation of the fracture occurred. Fractures consolidated within 32 (26-50) days and no new fractures were observed. These results suggest that this technique can be safely used in the treatment of extra-articular fractures as well as intra-articular fractures at the base of the first metacarpal.

Creating phyllotaxis: the stack-and-drag model.

The genesis of phyllotaxis, the origin of the pattern of appendages on the surface just below the apical extreme of many plants, is an old unsolved puzzle. Whereas many models generate helices, the stack-and-drag model is the first to achieve this in an integral construction from seed to flower. Combination of the principle of gnomonic growth, where consecutive additions have comparable positions, with a "dragging" principle, where the developing zone follows the apical tip, provides a powerful tool in simulating a wide range of phyllotactic manifestations. The influence of three vital parameters for primordial size, compressibility, and canalization (or annular arrangement) helps in understanding the problem's nature.

Creating phyllotaxis: the dislodgement model.

Assuming that neither the Fibonacci sequence nor any numerical ratio or angular deflection is specified in the genetic material of a plant cell, there must be an arranging mechanism effecting the sequence mentioned. Considering the ubiquity of the Fibonacci numbers in nature, embracing many species of flora, we expect a very simple geometrical law to be responsible. Success in finding such a law does not constitute a proof, but it is at the least an indication that we should look here with mathematical rather than biological eyes. The idea may seem self-evident. However, in the literature it has not yet been honored as the basis for constructing the phyllotaxis in centric, planar models. It is shown here that for the construction of a phyllotactic structure, no special angles or distances need be defined; natural growth functions can be used; planar, cylindrical, conical, and paraboloid constructions are possible within the same model; and constructions leading to accessory sequences and multijugate sequences can also be carried out.