Omokawa Shohei, Fujitani Ryotaro, Dohi Yoshihiro, Okawa Takumi, Yajima Hiroshi
Department of Orthopedics, Ishinkai-Yao General Hospital, Yao-city, Osaka, Japan.
J Hand Surg Am. 2008 Jul-Aug;33(6):857-63. doi: 10.1016/j.jhsa.2008.01.040.
The purpose of this study was to prospectively evaluate clinical results for open reduction and internal fixation of unstable metaphyseal fractures of the metacarpal and phalangeal bones using a miniature titanium plate.
Fifty-one consecutive patients with periarticular fractures with metaphyseal comminution and displacement were enrolled. Intra-articular involvement with a split or depression fracture was identified in 22 hands. Minimum follow-up was 1 year. There were 37 male and 14 female patients; average age was 38 years (range, 14-63). Of the 51 fractures, 15 were open; 8 of these had additional soft tissue injury, involving neurovascular injury in 4 and extensor tendon injury in 6. The average duration from injury to surgery was 6 days (range, 2-40 days).
Bone union was successfully achieved in all patients over an average period of 2.6 months. The final range of total active motion (%TAM) was excellent (>85%) for 26, good (70%-84%) for 17, fair (50%-69%) for 5, and poor (<49%) for 3. Postoperative complications occurred in 5 patients, including fracture redisplacement in 2, a collapse or absorption of the condylar head in 2, and superficial infection due to hardware exposure in one. Subsequently, 2 of these patients had malrotation deformities or osteoarthritic changes in the injured finger. Plates were removed in 30 cases, and additional surgery was required in 20 cases. Postoperative grip strength averaged 87% of the contralateral side. Statistical analysis revealed that patient age was significantly correlated with %TAM of the injured finger at 1-year follow-up (p < .01), and intra-articular (p < .05) and phalangeal bone (p < .01) involvement, as well as associated soft tissue injury (p < .05), significantly affected the range of finger motion.
Despite the technical demands of plating for comminuted metacarpal and phalangeal fractures, the low-profile titanium plate system was highly effective in maintaining anatomic reduction. The postoperative complication rate was relatively low, and the objective outcomes approached a reasonable level at 1-year follow-up.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在前瞻性评估使用微型钛板对掌骨和指骨不稳定干骺端骨折进行切开复位内固定的临床效果。
纳入51例连续的关节周围骨折合并干骺端粉碎和移位的患者。22只手存在关节内劈裂或凹陷骨折。最短随访时间为1年。男性37例，女性14例；平均年龄38岁（范围14 - 63岁）。51例骨折中，15例为开放性骨折；其中8例伴有额外的软组织损伤，4例涉及神经血管损伤，6例涉及伸肌腱损伤。受伤至手术的平均时间为6天（范围2 - 40天）。
所有患者平均在2.6个月时成功实现骨愈合。最终总的主动活动范围（%TAM）为优（>85%）的有26例，良（70% - 84%）的有17例，可（50% - 69%）的有5例，差（<49%）的有3例。5例患者出现术后并发症，包括2例骨折再移位，2例髁头塌陷或吸收，1例因内固定物外露导致浅表感染。随后，这些患者中有2例受伤手指出现旋转畸形或骨关节炎改变。30例患者取出了钢板，20例患者需要再次手术。术后握力平均为对侧的87%。统计分析显示，患者年龄与1年随访时受伤手指的%TAM显著相关（p < 0.01），关节内（p < 0.05）和指骨（p < 0.01）受累以及相关软组织损伤（p < 0.05）显著影响手指活动范围。
尽管对粉碎性掌骨和指骨骨折进行钢板固定有技术要求，但薄型钛板系统在维持解剖复位方面非常有效。术后并发症发生率相对较低，1年随访时客观结果接近合理水平。
研究类型/证据水平：治疗性IV级。
