Carpo-metacarpal dislocations are rare hand injuries. They are misdiagnosed due to their non-specific clinical signs. The authors report on their experience in the management of carpometacarpal dislocations in a speci...Carpo-metacarpal dislocations are rare hand injuries. They are misdiagnosed due to their non-specific clinical signs. The authors report on their experience in the management of carpometacarpal dislocations in a specialized hand surgery center. Our study included patients received and treated in the department for a carpometacarpal dislocation. Dislocation fractures of Bennett and Rolando were excluded. The postoperative functional evaluation took place after 18 months by the DASH score. Twelve patients participated: one case of neuro-algodystrophy and one pin infection. The mean DASH functional outcome score was 1.10 at 18 months. Since carpometacarpal dislocations are rare and easily misdiagnosed, the surgeon should assume the possibility of them in patients with high-energy trauma, and imaging studies should be carefully evaluated. Pinning is an effective treatment option that provides good long-term functional results.展开更多
Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium ...Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint(CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with percutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickD ASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.展开更多
目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架...目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架联合克氏针内固定治疗。对比两组的疗效和手术指标(手术时间、骨折愈合时间、住院时间),术后4周使用肩臂手功能障碍评分量表(Disabilities of the arm,shoulder and hand,DASH)评价患肢功能,使用视觉模拟评分法(Visual simulation scoring,VAS)评价患处疼痛程度并记录并发症。结果:观察组的治疗优良率高于对照组,手术时间长于对照组,骨折愈合时间、住院时间均比对照组缩短(P<0.05)。与治疗前相比,各治疗组DASH评分和VAS评分均明显降低(P<0.05),其中观察组DASH评分下降更为显著(P<0.05),但两组的VAS评分和并发症发生率均无差异(P>0.05)。结论:微型外固定架联合克氏针内固定治疗能提高疗效,促进掌骨骨折患者功能恢复,且不增加疼痛程度和并发症发生率。展开更多
目的分析应用Orthofix-微型器治疗第一掌骨基底部Bennett骨折的临床疗效。方法收集2009年1月-2013年1月我院31例采用Orthofix-微型器治疗的第一掌骨基底部Bennett骨折患者。记录患者年龄、性别等基线资料,以及术后上肢臂、肩、手功能调...目的分析应用Orthofix-微型器治疗第一掌骨基底部Bennett骨折的临床疗效。方法收集2009年1月-2013年1月我院31例采用Orthofix-微型器治疗的第一掌骨基底部Bennett骨折患者。记录患者年龄、性别等基线资料,以及术后上肢臂、肩、手功能调查量表（Disabilities of the arm,shoulder and hand,DASH）评分,随访终末期采用指总关节活动度（Total action movement,TAM）评分。结果随访6-24个月,平均14.4月,手术时间为18-40分钟,平均29.1分钟,术中出血量10-30m L,平均14.5m L。术后3月、术后6月及终末期DASH评分之间比较,差异均有统计学意义（P〈0.05）。随访终末期,其中26例解剖复位,5例骨折对线良好,TAM评分优22例,良7例,差2例。随访期间未发生桡神经浅支损伤、钉道感染等并发症。结论 Orthofix-微型外固定器治疗Bennett骨折操作简单、疗效满意。展开更多
Background： 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...Background： 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. Methods： 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. Results： 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°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.展开更多
目的采用三维有限元数值模拟方法分析比较骨水泥棒外固定支架与交叉克氏针在力学稳定性方面的差异,为手术治疗第五掌骨颈骨折(特别是第五掌骨颈开放性骨折)提供理论依据。方法选取1名健康志愿者,采集其手腕关节的三维CT图像数据,首先利...目的采用三维有限元数值模拟方法分析比较骨水泥棒外固定支架与交叉克氏针在力学稳定性方面的差异,为手术治疗第五掌骨颈骨折(特别是第五掌骨颈开放性骨折)提供理论依据。方法选取1名健康志愿者,采集其手腕关节的三维CT图像数据,首先利用Mimics Research 21.0、Geomagic Studio 2021软件进行三维图形数据处理,在此基础上应用Solidworks 2020软件构建第五掌骨颈骨折骨水泥棒外固定支架模型(A模型)和第五掌骨颈骨折交叉克氏针固定模型(B模型)。在ANSYS Workbench 17.0中对各模型的材料属性进行赋值、划分网格,建立三维有限元模型。最后通过在第五掌骨头远端关节面进行轴向施加和第五掌骨三点弯曲实验,计算得出两种施压方式的远端骨折块的最大位移,以此评价骨水泥棒外固定支架治疗第五掌骨颈骨折的稳定性。结果(1)轴向施压时,A模型远端骨折块的最大位移、最小位移和平均位移的值大于B模型,A模型近端骨折块的最大位移、最小位移和平均位移的值小于B模型,A模型最大相对位移、最小相对位移和平均相对位移大于B模型。(2)在三点折弯给力时,A模型远端骨折块最大位移小于B模型,远端骨折块最小位移等于B模型,近端骨折块的最大位移和最小位移的均值大于B模型,A模型最大相对位移、最小相对位移和平均相对位移大于B模型。(3)与B模型相比较,A模型的总体应力、固定物应力均明显较小。结论骨水泥棒外固定支架及克氏针交叉固定在治疗第五掌骨颈骨折方面,在轴向和纵向上的位移及总位移均未超过1 mm,差异较小;但骨水泥棒外固定支架在两种施力方式中与交叉克氏针相比应力更小,提示骨水泥棒外固定支架能提供可靠的力学稳定性。展开更多
文摘Carpo-metacarpal dislocations are rare hand injuries. They are misdiagnosed due to their non-specific clinical signs. The authors report on their experience in the management of carpometacarpal dislocations in a specialized hand surgery center. Our study included patients received and treated in the department for a carpometacarpal dislocation. Dislocation fractures of Bennett and Rolando were excluded. The postoperative functional evaluation took place after 18 months by the DASH score. Twelve patients participated: one case of neuro-algodystrophy and one pin infection. The mean DASH functional outcome score was 1.10 at 18 months. Since carpometacarpal dislocations are rare and easily misdiagnosed, the surgeon should assume the possibility of them in patients with high-energy trauma, and imaging studies should be carefully evaluated. Pinning is an effective treatment option that provides good long-term functional results.
文摘Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint(CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with percutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickD ASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.
文摘目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架联合克氏针内固定治疗。对比两组的疗效和手术指标(手术时间、骨折愈合时间、住院时间),术后4周使用肩臂手功能障碍评分量表(Disabilities of the arm,shoulder and hand,DASH)评价患肢功能,使用视觉模拟评分法(Visual simulation scoring,VAS)评价患处疼痛程度并记录并发症。结果:观察组的治疗优良率高于对照组,手术时间长于对照组,骨折愈合时间、住院时间均比对照组缩短(P<0.05)。与治疗前相比,各治疗组DASH评分和VAS评分均明显降低(P<0.05),其中观察组DASH评分下降更为显著(P<0.05),但两组的VAS评分和并发症发生率均无差异(P>0.05)。结论:微型外固定架联合克氏针内固定治疗能提高疗效,促进掌骨骨折患者功能恢复,且不增加疼痛程度和并发症发生率。
文摘目的分析应用Orthofix-微型器治疗第一掌骨基底部Bennett骨折的临床疗效。方法收集2009年1月-2013年1月我院31例采用Orthofix-微型器治疗的第一掌骨基底部Bennett骨折患者。记录患者年龄、性别等基线资料,以及术后上肢臂、肩、手功能调查量表（Disabilities of the arm,shoulder and hand,DASH）评分,随访终末期采用指总关节活动度（Total action movement,TAM）评分。结果随访6-24个月,平均14.4月,手术时间为18-40分钟,平均29.1分钟,术中出血量10-30m L,平均14.5m L。术后3月、术后6月及终末期DASH评分之间比较,差异均有统计学意义（P〈0.05）。随访终末期,其中26例解剖复位,5例骨折对线良好,TAM评分优22例,良7例,差2例。随访期间未发生桡神经浅支损伤、钉道感染等并发症。结论 Orthofix-微型外固定器治疗Bennett骨折操作简单、疗效满意。
文摘Background： 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. Methods： 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. Results： 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°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.
文摘目的采用三维有限元数值模拟方法分析比较骨水泥棒外固定支架与交叉克氏针在力学稳定性方面的差异,为手术治疗第五掌骨颈骨折(特别是第五掌骨颈开放性骨折)提供理论依据。方法选取1名健康志愿者,采集其手腕关节的三维CT图像数据,首先利用Mimics Research 21.0、Geomagic Studio 2021软件进行三维图形数据处理,在此基础上应用Solidworks 2020软件构建第五掌骨颈骨折骨水泥棒外固定支架模型(A模型)和第五掌骨颈骨折交叉克氏针固定模型(B模型)。在ANSYS Workbench 17.0中对各模型的材料属性进行赋值、划分网格,建立三维有限元模型。最后通过在第五掌骨头远端关节面进行轴向施加和第五掌骨三点弯曲实验,计算得出两种施压方式的远端骨折块的最大位移,以此评价骨水泥棒外固定支架治疗第五掌骨颈骨折的稳定性。结果(1)轴向施压时,A模型远端骨折块的最大位移、最小位移和平均位移的值大于B模型,A模型近端骨折块的最大位移、最小位移和平均位移的值小于B模型,A模型最大相对位移、最小相对位移和平均相对位移大于B模型。(2)在三点折弯给力时,A模型远端骨折块最大位移小于B模型,远端骨折块最小位移等于B模型,近端骨折块的最大位移和最小位移的均值大于B模型,A模型最大相对位移、最小相对位移和平均相对位移大于B模型。(3)与B模型相比较,A模型的总体应力、固定物应力均明显较小。结论骨水泥棒外固定支架及克氏针交叉固定在治疗第五掌骨颈骨折方面,在轴向和纵向上的位移及总位移均未超过1 mm,差异较小;但骨水泥棒外固定支架在两种施力方式中与交叉克氏针相比应力更小,提示骨水泥棒外固定支架能提供可靠的力学稳定性。
