Agee J
Hand Biomechanics Laboratory, Inc, Sacramento, California.
Orthop Clin North Am. 1992 Jan;23(1):35-40.
After a proximal phalangeal fracture, optimal results are obtained by methods that permit active interphalangeal joint motion and tendon gliding during fracture healing. Typical apex palmar angulation of proximal phalangeal fractures demonstrates dorsal skeletal shortening and secondary incompetence of the extensor mechanism with PIP joint extensor lag. Apex palmar deformities of the middle phalangeal fractures demonstrate similar problems with skeletal shortening resulting in loss of distal joint extension. Proximal and middle phalangeal shaft fracture deformities rotate about their flexor tendons and their fibro-osseous tunnels. Functional restoration requires accurate skeletal realignment that restores normal skeletal length necessary for extensor tendon competence. A splint that holds the wrist in slight extension and all four finger MP joints in full flexion combined with active interphalangeal joint exercises form the essential elements of postoperative care.
近端指骨骨折后，通过在骨折愈合期间允许指间关节主动活动和肌腱滑动的方法可获得最佳效果。近端指骨骨折典型的掌侧成角畸形表现为背侧骨骼缩短以及伸肌机制继发性功能不全伴近端指间关节伸肌滞后。中节指骨骨折的掌侧畸形表现出类似的骨骼缩短问题，导致远端关节伸展丧失。近端和中节指骨干骨折畸形围绕其屈肌腱及其纤维骨隧道旋转。功能恢复需要精确的骨骼复位，以恢复伸肌腱功能所需的正常骨骼长度。将腕关节保持在轻度伸展位且所有四个手指的掌指关节保持在完全屈曲位的夹板，结合指间关节主动练习，构成了术后护理的基本要素。
