RESUMO
PURPOSE: The objective of this study was to analyze complications and patient-related functional outcome after antegrade intramedullary Kirschner-wire fixation of metacarpal shaft fractures. METHODS: All consecutive patients treated from January 2010 until December 2015 were retrospectively analyzed using patient logs and radiographic images. Indications for operative fixation were angulation > 40°, shortening > 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-rated wrist/hand evaluation (PRWHE) and Disabilities of the Arm, Shoulder, and Hand score (DASH) questionnaire both ranging from 1 to 100 after a minimum follow-up of 6 months. RESULTS: During the study period, 34 fractures of 27 patients could be included. Mean outpatient follow-up was 11 weeks (range 4-24 weeks). The mean interval for functional assessment was 30 months (range 8-62 months) and 19 patients (70%) responded to the questionnaires. During outpatient follow-up, all fractures proceeded to union with no signs of secondary fracture dislocation or implant migration. One re-fracture after a new adequate trauma was seen and one patient underwent tenolysis due to persistent pain and impaired function. In 26 cases (81%), the K-wires were removed of which 23 (68%) were planned removals. Functional outcome was excellent with mean PRWHE and DASH scores of 7 and 5 points, respectively. CONCLUSIONS: If surgical treatment for metacarpal shaft fractures is considered, we recommend antegrade intramedullary K-wire fixation. This technique results in low complication rates and excellent functional outcome.
Assuntos
Fios Ortopédicos , Fixação Intramedular de Fraturas/métodos , Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Ossos Metacarpais/lesões , Adulto , Avaliação da Deficiência , Feminino , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Humanos , Masculino , Países Baixos , Medição da Dor , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A 14-year-old boy presented with a painful knee following a distorsion. He was unable to actively extend his lower leg. Conventional radiography showed no signs of a fracture. Both ultrasound imaging and MRI, however, demonstrated haemarthrosis and an osteochondral defect of the lateral femoral condyle. Apparently, an osteochondral lesion had developed due to patellar luxation. The osteochondral fragment was fixated using absorbable compression screws.
