Gupta Rakesh, Singh Roop, Siwach Rc, Sangwan Ss, Magu Narender K, Diwan Rahul
Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma, Post Graduate Institute of Medical Sciences, Rohtak - 124 001, Haryana, India.
Indian J Orthop. 2007 Jul;41(3):224-9. doi: 10.4103/0019-5413.33687.
Optimized functional results are difficult to achieve following hand injuries. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalangeal fractures.
Forty-five fractures of digits of hand in 31 patients were managed by surgical stabilization. Five fractures were fixed with closed reduction and percutaneous Kirschner wire fixation; 10 with external fixator; 26 with open reduction and Kirschner wire fixation; and four with open reduction and plate and screw or screw fixation.
Final evaluation of the patients was done at the end of three months. It was based on total active range of motion for digital functional assessment as suggested by the American Society for surgery of hand. Overall results were excellent to good in 87%. Better total active range of motion (excellent grade) was observed in metacarpal fractures (47%) versus phalanx fractures (31%); closed fractures (57%) versus open fractures (27%); and single digit involvement (55%) versus multiple digits (29%). Excellent total active range of motion was observed with all four plate and screw/ screw fixation technique (100%) and closed reduction and percutaneous kirschner wire fixation (60%). Twenty-two complications were observed in 10 patients with finger stiffness being the most common.
Surgical stabilization of metacarpal and phalangeal fractures of hand seems to give good functional outcome. Closed fractures and fractures with single digit involvement have shown a better grade of total active range of motion.
手部受伤后很难实现最佳功能恢复。本前瞻性研究旨在评估掌骨和指骨骨折手术固定后的功能结局。
对31例患者手部的45处指骨骨折进行手术固定治疗。5处骨折采用闭合复位经皮克氏针固定；10处采用外固定架固定；26处采用切开复位克氏针固定；4处采用切开复位钢板螺钉或螺钉固定。
在三个月结束时对患者进行最终评估。评估依据美国手外科协会建议的用于手指功能评估的总主动活动范围。总体结果87%为优至良。掌骨骨折（47%）的总主动活动范围优于指骨骨折（31%）；闭合性骨折（57%）优于开放性骨折（27%）；单指损伤（55%）优于多指损伤（29%）。采用所有四种钢板螺钉/螺钉固定技术（100%）和闭合复位经皮克氏针固定（60%）时总主动活动范围为优。10例患者出现22种并发症，其中手指僵硬最为常见。
手部掌骨和指骨骨折的手术固定似乎能带来良好的功能结局。闭合性骨折和单指损伤的总主动活动范围等级更佳。
