Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl). 2009 Nov 5;122(21):2616-9.
Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons. Inappropriate management of these injuries may result in chronic pain, stiffness, deformity, or post traumatic arthritis. Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization. The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.
From May 2005 to May 2007, a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation. Of the 26 cases, 11 involved in metacarpophalangeal joint, and 15 interphalangeal joint in proximal interphalangeal. Kirschner wire, mini wire and absorbable suture were used for limited internal fixation. All patients were followed up and patients were accomplished with total active motion (TAM) of fingers.
All patients were reviewed by an independent observer. The mean follow up was 13 months (range 9 to 24 months). Subjective, objective and radiographic results were evaluated. X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5 - 12 weeks and the phalange shortening or rotation in 2 cases, joint incongruity (less than 1 mm) and joint space narrowing in 3 cases respectively. Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases. An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery. Based on TAM the overall good-excellent rate of joint motion function was 80.8%.
Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.
手指关节内骨折是急诊医师和手外科医师常见的问题。这些损伤处理不当可能导致慢性疼痛、僵硬、畸形或创伤后关节炎。理想的治疗需要恢复稳定且一致的关节，以允许早期活动。本研究旨在探讨微型外固定器结合有限内固定治疗手指关节内骨折的疗效。
2005 年 5 月至 2007 年 5 月，采用微型外固定器结合有限内固定治疗 26 例手指关节内骨折患者。26 例中，掌指关节 11 例，近节指间关节 15 例。采用克氏针、微型钢丝和可吸收缝线进行有限内固定。所有患者均获得随访，完成手指总主动活动度（TAM）。
所有患者均由独立观察者进行评估。平均随访时间为 13 个月（9 至 24 个月）。评估了主观、客观和影像学结果。X 线片显示骨折愈合，平均影像学愈合时间为 7 周，范围为 5-12 周，2 例出现指骨缩短或旋转，3 例出现关节不平整（小于 1mm）和关节间隙变窄。2 例出现指骨缩短或旋转，3 例出现关节不平整或关节间隙变窄。1 例术后 1.5 年因创伤性关节炎行人工植入物治疗。根据 TAM，关节活动功能的总体优良率为 80.8%。
微型外固定器结合有限内固定是治疗手指关节内骨折的可靠有效方法。
