Henry Mark
Hand and Wrist Center of Houston, Houston, TX 77004, USA.
Tech Hand Up Extrem Surg. 2008 Sep;12(3):161-5. doi: 10.1097/BTH.0b013e318174dc0a.
Proximal phalangeal fractures often lead to motion loss at the proximal interphalangeal joint primarily because of adhesions between the zone 4 extensor tendon and the fracture site. This most commonly manifests as an extensor lag at the proximal interphalangeal joint, but can also include incomplete recovery of flexion range. The occurrence of the fracture alone likely generates some degree of insurmountable motion loss. Additional motion loss may be iatrogenic based on the specific surgical technique and rehabilitation strategy. It has been promoted that percutaneous pinning methods, as opposed to open fixation methods, produce less of a motion deficit. Although percutaneous pinning solves many fractures of the proximal phalanx, some fracture patterns will not be adequately treated by percutaneous pinning and will benefit from direct open reduction and internal fixation. Spiral fractures with a significant rotational deformity are well treated by lag screws. Comminuted fractures are well treated by plate fixation. When performing such fixations, the soft tissue approach to the fracture site plays a substantial role in determining the ultimate functional recovery. This article covers the specific technical details of optimizing soft tissue management when performing open fixation for proximal phalanx fractures.
近端指骨骨折常常导致近端指间关节活动丧失，主要原因是4区伸肌腱与骨折部位之间形成粘连。这最常见的表现是近端指间关节伸肌滞后，但也可能包括屈曲范围无法完全恢复。仅骨折的发生就可能导致一定程度的无法克服的活动丧失。基于特定的手术技术和康复策略，额外的活动丧失可能是医源性的。有人提出，与切开复位固定方法相比，经皮穿针固定方法产生的活动缺损较小。虽然经皮穿针解决了许多近端指骨骨折问题，但一些骨折类型无法通过经皮穿针得到充分治疗，而直接切开复位内固定会使其受益。伴有明显旋转畸形的螺旋骨折用拉力螺钉治疗效果良好。粉碎性骨折用钢板固定治疗效果良好。进行此类固定时，骨折部位的软组织处理方法在决定最终功能恢复方面起着重要作用。本文涵盖了对近端指骨骨折进行切开复位固定时优化软组织处理的具体技术细节。
