Objective To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius. Methods A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. Results All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). Conclusion Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
Objective
To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method.
Methods
The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus.
Results
During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups (P<0.05).
Conclusion
Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.
The applied anatomy and clinical application were described in this paper. The blood supply of this flap was based on the second dorsal metacarpal artery. It gave some advantages of as easy of application, safe and reliable. Since November 1990, we had successfully used six such flaps in covering the soft tissue defects of the hand.
Objective
To investigate the diagnose and treatment of intra-articular fracture of the 5th metacarpale base with carpometacarpal joint dislocation (reverse Bennett fracture).
Methods
Between January 2008 and March 2012, 26 cases of reverse Bennett fracture were treated. There were 20 males and 6 females, aged 19-48 years (mean, 26 years). The injury causes included boxing injury in 19 cases, falling injury in 3 cases, heavy pound injury in 3 cases, and crushing injury in 1 case. According to Lundeen classification, there were 8 cases of type A, 9 cases of type B, 3 cases of type C, and 6 cases of type D. The time from injury to operation ranged 1-8 days with an average of 4 days. All patients underwent open reduction and internal fixation with Kirschner wires, screws, or plates by L-shaped dorsal incision.
Results
Primary healing was obtained in all incisions; no infection, hematoma, and necrosis occurred after operation. All patients were followed up with an average time of 12.5 months (range, 8-24 months). X-ray films showed that all fractures healed after 6-8 weeks (mean, 6.5 weeks); no delayed union or nonunion and no the 5th carpometacarpal joint dislocation were observed. Two cases had mild osteoarthritis. According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 22 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 96.2%.
Conclusion
For patients with reverse Bennett fracture, good results can be obtained if early diagnose is done and appropriate internal fixation is selected.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.
Objective To assess the clinical effect of microsurgicaltreatment for bone defect of the first carpometacarpal joint. Methods From February 2001 to August 2004, the pedicled free graft of second tarsometatarsal joint was transplanted to repair bone defect of the first carpometacarpal joint according to the shape and area of tissue defect of hand in 3 patients. The dosalis pedis flap was simultaneously used to repair soft tissue defect of carpometacarpe and the big thenar in 2 cases. The donor site was sutured directly or covered byintermediate thickness skin flap. Results The vessel of the bone flaphad constant anatomical location，the operation procedure was easy. Moreover it had minimal effect ondonor, the flap of dosalis pedis could be used to repair soft tissue defect in this area. Three cases were followed up 1 to 2 years.The shape of the reconstituted thumb was normal. The healing time of clinical fracture of the first carpometacarpal joint was 2 to 3 months. The function recovery of the reconstituted thumb was satisfactory. Conclusion It is an effective method to repair bonedefect of the first carpometacarpal joint with the pedicled second tarsometatarsal joint graft.
Objective To summarize the clinical experiences of various types of the second dorsal metacarpal artery (SDMA) flap for hand reconstruction. Methods From 1988 to 2003, 139 SDMA flaps were transferred for hand injuries. The flaps were used in 5 types according to vascularization and technique in transplantation:orthograde pedicled island SDMA flaps in 37 cases (cutaneous in 24and teno-cutaneous in 13), retrograde pedicled island SDMA flaps in 25 cases(cutaneous in 19 and teno-cutaneous in 6),double pivot SDMA flaps in 36 cases(cutaneous in 28 and teno-cutaneous in 8), distal perforator branch pedicledflaps in 19cases (cutaneous in 16 and composite in 3), free SDMA flaps in 22 cases (cutaneous in 15 and composite in 7). The skin islands were 3.0 cm×1.5 cm to 6.3 cm×5.0 cm in size. Results Of the 139 flaps, 135 flaps survived completely, 3 survived partially, and1 failed in the operation because of intractable vascular spasm. Follow-up wasdone in 116 cases for 12 to 57 months. The flap had good texture and color match. The twopoint discrimination was 5 to 9 mm in 78 sensate flaps, while it was 10 to 15 mm in 38 nonsensate flaps. In 21 tenocutaneous flaps, the TAM score of range of motion was 60% to 70% of the healthy side. Conclusion The SDMA flap has a constant and reliable vessel and a thin, pliable, and good-quality skin. It is versatile in creatingcomposite flaps. It is a good flap resource for hand and finger reconstruction.
Objective To explore the effectiveness of partial translocation of flexor carpi radialis tendon in the treatment of traumatic dislocation of the first carpometacarpal joint. Methods The clinical data of 6 patients with traumatic dislocation of the first carpometacarpal joint who met the selection criteria between March 2020 and June 2024 were retrospectively analyzed. There were 3 males and 3 females with an average age of 33.5 years (range, 16-42 years). All the 6 cases were treated with plaster immobilization for 4-6 weeks, and the time from injury to operation was 6-12 weeks, with an average of 8.8 weeks. All patients underwent reconstruction of the metacarpophalangeal anterior oblique ligament and dorsal posterior oblique ligament of the first carpometacarpal joint with partial translocation of flexor carpi radialis tendon. The pain relief was evaluated by visual analogue scale (VAS) score before and after operation, and the pinch force, palmar abduction and radial abduction angles of the affected side and the healthy side were recorded before and after operation, and the ratio of the above indexes between the affected side and the healthy side was calculated to evaluate the effectiveness. ResultsAll the incisions healed by first intention after operation, and there was no complication related to operation such as neurovascular injury. All patients were followed up 6-19 months (mean, 12.7 months). The range of motion of the thumb on the affected side was the same as that on the healthy side, the first carpometacarpal joint was stable without recurrent dislocation and pain. At last follow-up, the VAS score, the pinch force of the affected side, the abduction angle of the palmar side of the affected thumb, the abduction angle of the radial side of the affected thumb, and the pinch force ratio, the palmar abduction angle ratio of the thumb, and the radial abduction angle ratio of the thumb of the affected side to the healthy side significantly improved when compared with those before operation (P<0.05). ConclusionPartial translocation of the flexor carpi radialis tendon to reconstruct the metacarpophalangeal and dorsal radial ligaments for the treatment of traumatic dislocation of the first carpometacarpal joint is a reliable surgical method.
ObjectiveTo investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. MethodsBetween February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. ResultsThe distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. ConclusionThe double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.
Objective To investigate the operative procedure and the cl inical results of the modified island flap based on the reversed dorsal metacarpal artery for repairing finger tissue defect. Methods From January 2004 to March 2009, 38 patients (43 fingers) with finger tissue defect were treated with the modified island flaps based on the reversed dorsal metacarpal artery. The deverting point was altered from the dorsal point to the palm. There were 27 males (31 fingers) and 11 females (12 fingers) with an average age of 43.6 years (range, 12-67 years). Defect was caused by crash injury in 18 cases, crush injury in 14 cases, and cutting injury in 6 cases. Of them, 11 index fingers, 23 middle fingers, 7 ring fingers, and 2 l ittle fingers were involved. The area of the defect ranged from 1.0 cm × 0.7 cm to 3.2 cm × 2.5 cm. The area of flaps ranged from 1.2 cm × 1.0 cm to 3.5 cm × 2.8 cm. The donor sites were sutured directly. Results Tension vesicular scabbing occurred in distal part of flap, and was cured after dressing change in 3 cases. The other flaps survived and incision healed primarily. All incision at donor sites healed primarily. Thirty-one patients (35 fingers) were followed up 6-29 months (15.3 months on average). All flaps survived with satisfactory appearance, sensation, and function. Two-point discrimination was 6-9 mm (7.9 mm on average). The results were excellent in 20 fingers, good in 13 fingers, and fair in 2 fingers according to the total active movement (TAM) standards; the excellent and good rate was 94.3%. Conclusion The treatment of finger tissue defect with the modified island flap based on the reversed dorsal metacarpal artery is recommendable. The deverting point was altered from the dorsal point to the palm. The vessel pedicle is extended. It can be easily and conveniently performed for more cases.
